Provider Demographics
NPI:1093109795
Name:MEDICAL ASSOCIATES OF GEORGIA
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-691-3388
Mailing Address - Street 1:3584 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4465
Mailing Address - Country:US
Mailing Address - Phone:678-691-3388
Mailing Address - Fax:678-395-7702
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:307
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-938-5552
Practice Address - Fax:678-395-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty