Healthcare Provider Details

I. General information

NPI: 1831548536
Provider Name (Legal Business Name): NEDA HABEEB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MEDICAL CENTER DR
RIVERDALE GA
30274-2640
US

IV. Provider business mailing address

3031 W GRAND BLVD STE 450
DETROIT MI
48202-3026
US

V. Phone/Fax

Practice location:
  • Phone: 678-674-4004
  • Fax:
Mailing address:
  • Phone: 313-871-3751
  • Fax: 313-879-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301116873
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number89882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: