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General NPI Number Information
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NPI Number | 1982783304
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Entity Type | Organization
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Legal Business Name | MUMTAZ MUMTAZ INC
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 2404 MACY DR
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City | ROSWELL
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State | GA
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Zip | 30076-6343
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Country | US
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Telephone | 770-640-8814
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Fax | 770-640-8815
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Provider Business Mailing Address
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Address Line | 2404 MACY DR
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City | ROSWELL
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State | GA
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Zip | 30076-6343
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Country | US
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Telephone | 770-640-8814
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Fax | 770-640-8815
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARZANA B MUMTAZ
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Credential | M.D.
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Telephone | 770-640-8814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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