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General NPI Number Information
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NPI Number | 1760023121
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Entity Type | Organization
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Legal Business Name | GREATER ATLANTA MD INC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 301 GWINNETT DR STE D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5670
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Country | US
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Telephone | 678-841-5240
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Fax | 404-759-2694
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Provider Business Mailing Address
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Address Line | PO BOX 681
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-0681
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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 | CEO/PRESIDENT
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Name | FALAHAT ALI FAROOQUI
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Credential | MD
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Telephone | 678-333-5396
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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