=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275638140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIYA GHANI ZIA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 07/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1705 W MAIN ST
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85201-6920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-809-5092
-----------------------------------------------------
Fax | 480-840-1834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 562 CONCORD RD SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30082-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-384-9900
-----------------------------------------------------
Fax | 770-384-9912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A83657
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 78256
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------