Provider Demographics
NPI:1013187780
Name:NIA, FARHAD FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:FRANK
Last Name:NIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 LAKE FORREST DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2216
Mailing Address - Country:US
Mailing Address - Phone:404-345-2757
Mailing Address - Fax:
Practice Address - Street 1:1867 JONESBORO RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6099
Practice Address - Country:US
Practice Address - Phone:678-432-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice