Provider Demographics
NPI:1235234527
Name:HUSAIN, MIR ABID (MD)
Entity Type:Individual
Prefix:MR
First Name:MIR
Middle Name:ABID
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1700 HOSPITAL SOUTH DRIVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:770-739-8282
Mailing Address - Fax:770-739-0794
Practice Address - Street 1:1700 HOSPITAL SOUTH DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-739-8282
Practice Address - Fax:770-739-0794
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52276207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA674793815AMedicaid
G05581Medicare UPIN
44ZCBJQMedicare ID - Type Unspecified