Healthcare Provider Details

I. General information

NPI: 1154590982
Provider Name (Legal Business Name): DR. SYED W. RIZVI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 10/15/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLONIAL CENTER PKWY
ROSWELL GA
30076-4899
US

IV. Provider business mailing address

770 CHAMPIONS CLOSE
ALPHARETTA GA
30004-0949
US

V. Phone/Fax

Practice location:
  • Phone: 678-575-0288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number044073
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SYED W. RIZVI
Title or Position: MD
Credential: MD
Phone: 678-575-0288