MEDICARE: ZOBIYA Z MOMIN MD

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	390200000X	Student in an Organized Health Care Education/Training Program		TX
2	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	88382	GA
3	208000000X	Pediatrics Physician	88382	GA

General Provider Information

NPI Number	:	1578067526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOBIYA Z MOMIN MD

Provider Business Mailing Address
First Line	:	1547 CLIFTON RD NE FL 2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-4008
Country	:	US
Telephone Number	:	404-543-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1547 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-3411
Country	:	US
Telephone Number	:	404-543-4268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	07/30/2024

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