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General NPI Number Information
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NPI Number | 1871145672
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Entity Type | Individual
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Provider Name | FAREEM JIVRAJ OD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 3393 PEACHTREE RD NE STE B128
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City | ATLANTA
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State | GA
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Zip | 30326-1197
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Country | US
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Telephone | 857-269-6286
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Fax |
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Provider Business Mailing Address
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Address Line | 3394 BRYERSTONE CIR SE
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City | SMYRNA
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State | GA
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Zip | 30080-4810
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Country | US
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Telephone | 857-269-6286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT003170
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License Number State | GA
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