Provider Demographics
NPI:1518283308
Name:SIDDIQI, AMEERA WASEEM (MD)
Entity Type:Individual
Prefix:
First Name:AMEERA
Middle Name:WASEEM
Last Name:SIDDIQI
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 1:1265 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4548
Mailing Address - Country:US
Mailing Address - Phone:678-435-3040
Mailing Address - Fax:678-435-3044
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:678-435-3040
Practice Address - Fax:678-435-3044
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69443207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134819AMedicaid
GA202I442939Medicare PIN