Provider Demographics
NPI:1396817532
Name:NIAZ, SAIRA T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIRA
Middle Name:T
Last Name:NIAZ
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 1:2523 PANOLA RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4831
Mailing Address - Country:US
Mailing Address - Phone:770-322-9660
Mailing Address - Fax:770-322-1981
Practice Address - Street 1:2523 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4831
Practice Address - Country:US
Practice Address - Phone:770-322-9660
Practice Address - Fax:770-322-1981
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA981194918DMedicaid
GAI68430Medicare UPIN