Provider Demographics
NPI:1972826576
Name:MUSTAFA, ZIA (DPM)
Entity Type:Individual
Prefix:
First Name:ZIA
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:8855 HOSPITAL DR.
Practice Address - Street 2:STE. 150
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2267
Practice Address - Country:US
Practice Address - Phone:678-838-4443
Practice Address - Fax:678-838-4083
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3382213ES0103X
GAPOD001210213ES0103X
GAPOD0001210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2066Medicare PIN
GA202I485827Medicare PIN