Provider Demographics
NPI:1922058023
Name:NIAZ, FAIZ EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIZ
Middle Name:EHSAN
Last Name:NIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RIVER PARK NORTH DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7835
Mailing Address - Country:US
Mailing Address - Phone:770-345-0070
Mailing Address - Fax:770-345-0077
Practice Address - Street 1:245 RIVER PARK NORTH DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7835
Practice Address - Country:US
Practice Address - Phone:770-345-0070
Practice Address - Fax:770-345-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN310322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA500625107BMedicaid
TN3731622Medicaid
GA500625107AOtherMEDICAID
670593Medicare UPIN
TNG70593Medicare UPIN
TN3731622Medicare ID - Type Unspecified