Provider Demographics
NPI:1760823132
Name:CHOWDHURY, FATHIMA (PA-C)
Entity Type:Individual
Prefix:
First Name:FATHIMA
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 DURHAM VIEW CT NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5896
Mailing Address - Country:US
Mailing Address - Phone:678-755-0756
Mailing Address - Fax:
Practice Address - Street 1:11500 STATE HIGHWAY 121 STE 930
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9347
Practice Address - Country:US
Practice Address - Phone:469-200-4093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11372363A00000X
NY016560-1363A00000X
MAPA4702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical