Provider Demographics
NPI:1912285289
Name:NISAR A.PIRACHA,MD.PC
Entity Type:Organization
Organization Name:NISAR A.PIRACHA,MD.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLPROPRITOR
Authorized Official - Prefix:
Authorized Official - First Name:NISAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIRACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-736-1735
Mailing Address - Street 1:2331 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3155
Mailing Address - Country:US
Mailing Address - Phone:770-736-1735
Mailing Address - Fax:770-736-1228
Practice Address - Street 1:2331 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3155
Practice Address - Country:US
Practice Address - Phone:770-736-1735
Practice Address - Fax:770-736-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026745208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92222Medicare PIN