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General NPI Number Information
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NPI Number | 1063925543
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Entity Type | Organization
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Legal Business Name | SULTANA FAIYAZ CORPORATION, LLC
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 4208 AMBERLEAF WALK
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City | LILBURN
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State | GA
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Zip | 30047-3157
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Country | US
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Telephone | 937-344-9061
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 AMBERLEAF WALK
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City | LILBURN
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State | GA
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Zip | 30047-3157
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | MR. SYED ATIF ALI
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Credential |
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Telephone | 770-910-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 075784
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License Number State | GA
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