Healthcare Provider Details

I. General information

NPI: 1184061681
Provider Name (Legal Business Name): HOASHAFEE HEALTH MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

PO BOX 1188
LILBURN GA
30048-1188
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-2377
  • Fax:
Mailing address:
  • Phone: 770-910-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SYED A ALI
Title or Position: PARTNER
Credential:
Phone: 770-910-2377