Healthcare Provider Details

I. General information

NPI: 1912144155
Provider Name (Legal Business Name): SAIRA TARIQ NIAZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 PANOLA RD
LITHONIA GA
30058-4831
US

IV. Provider business mailing address

2523 PANOLA RD
LITHONIA GA
30058-4831
US

V. Phone/Fax

Practice location:
  • Phone: 770-322-9660
  • Fax: 770-322-1981
Mailing address:
  • Phone: 770-322-9660
  • Fax: 770-322-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASIA TUCKER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-322-9660