Provider Demographics
NPI:1972839744
Name:MOHAMMAD-NIA, SAM (DC)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:MOHAMMAD-NIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6690 ROSWELL RD NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3161
Mailing Address - Country:US
Mailing Address - Phone:678-999-8531
Mailing Address - Fax:404-497-9757
Practice Address - Street 1:6690 ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3161
Practice Address - Country:US
Practice Address - Phone:678-999-8531
Practice Address - Fax:404-497-9757
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor