MEDICARE: RIZWAN RIYAZ M.D.

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	207P00000X	Emergency Medicine Physician	3980	GA

General Provider Information

NPI Number	:	1992036537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIZWAN RIYAZ M.D.

Provider Business Mailing Address
First Line	:	3450 MILLER DR
Second Line	:	APPARTMENT #1228
City	:	ATLANTA
State	:	GA
Zip	:	30341-2726
Country	:	US
Telephone Number	:	678-510-9236
Fax Number	:	404-230-8967

Provider Business Practice Location Address
First Line	:	50 HURT PLZ SE STE 600
Second Line	:	GEORGIA POISON CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30303-2915
Country	:	US
Telephone Number	:	678-510-9236
Fax Number	:	404-230-8967

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

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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