Healthcare Provider Details

I. General information

NPI: 1669040093
Provider Name (Legal Business Name): MUHAMMAD HAMZA MIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLONIAL CENTER PKWY STE 100
ROSWELL GA
30076-4892
US

IV. Provider business mailing address

1732 BRENTWOOD DR
TROY MI
48098-2630
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 305-331-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4351048760
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: