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General NPI Number Information
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NPI Number | 1912285289
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Entity Type | Organization
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Legal Business Name | NISAR A.PIRACHA,MD.PC
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 2331 HENRY CLOWER BLVD SUITE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-3155
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Country | US
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Telephone | 770-736-1735
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Fax | 770-736-1228
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Provider Business Mailing Address
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Address Line | 2331 HENRY CLOWER BLVD SUITE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-3155
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Country | US
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Telephone | 770-736-1735
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Fax | 770-736-1228
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Authorized Official
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Title or Position | SOLPROPRITOR
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Name | NISAR A PIRACHA
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Credential | MD
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Telephone | 770-736-1735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 026745
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License Number State | GA
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