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General NPI Number Information
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NPI Number | 1881953743
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Entity Type | Organization
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Legal Business Name | TARIQ H MIRZA MD INC
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 5038 OLD DIXIE HWY
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City | FOREST PARK
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State | GA
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Zip | 30297-2148
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Country | US
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Telephone | 404-366-0303
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Fax | 678-228-2021
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Provider Business Mailing Address
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Address Line | 5038 OLD DIXIE HWY
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City | FOREST PARK
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State | GA
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Zip | 30297-2148
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Country | US
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Telephone | 404-366-0303
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Fax | 678-228-2021
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Authorized Official
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Title or Position | PRESIDENT
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Name | TARIQ H MIRZA
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Credential | MD
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Telephone | 404-366-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 032961
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License Number State | GA
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