Provider Demographics
NPI:1881687275
Name:QAZI, FARID U
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:U
Last Name:QAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5853 KENTUCKY DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5308
Mailing Address - Country:US
Mailing Address - Phone:478-405-6010
Mailing Address - Fax:478-275-1191
Practice Address - Street 1:207 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2550
Practice Address - Country:US
Practice Address - Phone:478-275-1111
Practice Address - Fax:478-275-1191
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52450516OtherBCBS NUMBER
GAGRP4933OtherMEDICARE GROUP ID
GAGRP4933OtherMEDICARE GROUP ID
GA83BBBRFMedicare ID - Type Unspecified