MEDICARE: BALD RIDGE FAMILY PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437932019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALD RIDGE FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	1230 BALD RIDGE MARINA RD STE 400
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 BALD RIDGE MARINA RD STE 400
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7859
Country	:	US
Telephone Number	:	470-826-1905
Fax Number	:	470-826-3334

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SHEBA NAQVI
Credential	:	MD
Telephone Number	:	678-640-1650

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/18/2023

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