Provider Demographics
NPI:1285660985
Name:FAIYAZ, UNNISA (MD)
Entity Type:Individual
Prefix:DR
First Name:UNNISA
Middle Name:
Last Name:FAIYAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1451
Mailing Address - Country:US
Mailing Address - Phone:770-487-7807
Mailing Address - Fax:770-487-7619
Practice Address - Street 1:2579 HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1451
Practice Address - Country:US
Practice Address - Phone:770-487-7807
Practice Address - Fax:770-487-7619
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE54856Medicare UPIN