Provider Demographics
NPI:1851962724
Name:AHMAD, MAIDA IMTIAZ (OD)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:IMTIAZ
Last Name:AHMAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 1201
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4550
Mailing Address - Country:US
Mailing Address - Phone:678-381-2020
Mailing Address - Fax:678-381-2015
Practice Address - Street 1:201 KIMBERLY WAY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8010
Practice Address - Country:US
Practice Address - Phone:678-381-2020
Practice Address - Fax:678-381-2015
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003333OtherPROFESSIONAL LICENSE