Provider Demographics
NPI:1639123136
Name:FADIA, PAYAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:M
Last Name:FADIA
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 1:2020 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1426
Mailing Address - Country:US
Mailing Address - Phone:404-367-1347
Mailing Address - Fax:404-350-7694
Practice Address - Street 1:1942 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3406
Practice Address - Country:US
Practice Address - Phone:404-367-1347
Practice Address - Fax:404-350-7694
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061773208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA732851504AMedicaid
GA732851504AMedicaid