Healthcare Provider Details

I. General information

NPI: 1407006802
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY OF NORTH GEORGIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/21/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

IV. Provider business mailing address

245 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-0700
  • Fax: 770-345-0077
Mailing address:
  • Phone: 770-345-0700
  • Fax: 770-345-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number060948
License Number StateGA

VIII. Authorized Official

Name: FAIZ E NIAZ
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 770-345-0070