Healthcare Provider Details

I. General information

NPI: 1710246848
Provider Name (Legal Business Name): SYEDA HAMADANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GWINNETT DR
LAWRENCEVILLE GA
30046-5669
US

IV. Provider business mailing address

301 GWINNETT DR SW, LAWRENCEVILLE, GA 30046
LAWRENCEVILLE GA
30046
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9196
  • Fax: 770-910-9197
Mailing address:
  • Phone: 770-910-9196
  • Fax: 770-910-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84919
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number84919
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: