Healthcare Provider Details

I. General information

NPI: 1225565666
Provider Name (Legal Business Name): FARIA ALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 COUNTRY CLUB DR STE 100
STOCKBRIDGE GA
30281-9069
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW STE 800
ATLANTA GA
30318-0922
US

V. Phone/Fax

Practice location:
  • Phone: 678-854-9500
  • Fax: 678-854-9502
Mailing address:
  • Phone: 678-298-3239
  • Fax: 404-477-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number89760
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number112862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: