Healthcare Provider Details

I. General information

NPI: 1760651806
Provider Name (Legal Business Name): DR. MINIYARS PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 TURNER MCCALL BLVD SW SUITE 1050
ROME GA
30165-5630
US

IV. Provider business mailing address

330 TURNER MCCALL BLVD SW SUITE 1050
ROME GA
30165-5630
US

V. Phone/Fax

Practice location:
  • Phone: 706-232-1300
  • Fax: 706-232-1039
Mailing address:
  • Phone: 706-232-1300
  • Fax: 706-232-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051597
License Number StateGA

VIII. Authorized Official

Name: DR. RAJ MINIYAR
Title or Position: OWNER
Credential: M.D.
Phone: 706-232-1300