Provider Demographics
NPI:1326210899
Name:MIAN, HAROON AFZAL (MD)
Entity Type:Individual
Prefix:
First Name:HAROON
Middle Name:AFZAL
Last Name:MIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:460 NORTHSIDE CHEROKEE BLVD
Mailing Address - Street 2:STE 170
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-721-9170
Mailing Address - Fax:770-721-9171
Practice Address - Street 1:10515 BELLS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4204
Practice Address - Country:US
Practice Address - Phone:678-493-0752
Practice Address - Fax:678-493-2401
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127721GMedicaid
KY111291OtherSIHO
GA003127721FMedicaid
KY000000645993OtherANTHEM
GA20208I0658Medicare PIN
KY111291OtherSIHO