Healthcare Provider Details

I. General information

NPI: 1417487356
Provider Name (Legal Business Name): MEHRIN JAWAID DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/21/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE LOWR LEVEL
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

11731 POINTE PL
ROSWELL GA
30076-4636
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5186
  • Fax:
Mailing address:
  • Phone: 770-793-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number91322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: