Provider Demographics
NPI:1346238961
Name:RIZVI, SYED FARHAN MAHMOOD (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:FARHAN MAHMOOD
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 LEE PARKWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1741
Mailing Address - Country:US
Mailing Address - Phone:423-855-2552
Mailing Address - Fax:423-855-9041
Practice Address - Street 1:2341 MCCALLIE AVE
Practice Address - Street 2:PLAZA 3, SUITE 403
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3239
Practice Address - Country:US
Practice Address - Phone:423-697-4567
Practice Address - Fax:423-697-0047
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN031337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000902987BMedicaid
H03494Medicare UPIN
GA000902987BMedicaid
TN3846140Medicare ID - Type Unspecified