Provider Demographics
NPI:1568517720
Name:TARIQ JAVED, M.D., P.C.
Entity Type:Organization
Organization Name:TARIQ JAVED, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-422-0444
Mailing Address - Street 1:631 CAMPBELL HILL ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1301
Mailing Address - Country:US
Mailing Address - Phone:770-422-0444
Mailing Address - Fax:770-422-4412
Practice Address - Street 1:631 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1301
Practice Address - Country:US
Practice Address - Phone:770-422-0444
Practice Address - Fax:770-422-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34376174400000X
GA003649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001357AMedicaid
GA00349499AMedicaid
GA00470148BMedicaid
GA14BDHHXMedicare ID - Type UnspecifiedTARIQ JAVED, M.D. MEDICA
GA00349499AMedicaid
GAP00085480Medicare ID - Type UnspecifiedRAILROAD MCARE T.JAVED
GAD95781Medicare UPIN
GA00470148BMedicaid