Provider Demographics
NPI:1376631689
Name:MIAN, NOSHEEN AMIR (MD)
Entity Type:Individual
Prefix:
First Name:NOSHEEN
Middle Name:AMIR
Last Name:MIAN
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8274
Mailing Address - Fax:706-798-8626
Practice Address - Street 1:2011 WINDSOR SPRING RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4957
Practice Address - Country:US
Practice Address - Phone:706-798-1700
Practice Address - Fax:706-798-8626
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR785873OtherHEALTHLINK
GA90004OtherLICENSE
AR07110012300OtherQUALCHOICE
AR163962001Medicaid
AR7940907OtherAETNA
GA90004OtherLICENSE
ARI71867Medicare UPIN