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General NPI Number Information
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NPI Number | 1982010120
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Entity Type | Organization
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Legal Business Name | ACWORTH CENTER FOR FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 3466 COBB PKWY SUITE 170
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City | ACWORTH
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State | GA
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Zip | 30101
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Country | US
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Telephone | 770-203-1711
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Fax | 404-855-4104
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Provider Business Mailing Address
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Address Line | 1867 JONESBORO RD SUITE 6
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City | MCDONOUGH
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State | GA
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Zip | 30253-6099
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Country | US
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Telephone | 678-432-0209
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Fax | 404-855-4104
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. FARHAD NIA
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Credential | DMD
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Telephone | 770-203-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013645
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License Number State | GA
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