Provider Demographics
NPI:1952603201
Name:FAREED, SURAYYAH W (NPCNM)
Entity Type:Individual
Prefix:
First Name:SURAYYAH
Middle Name:W
Last Name:FAREED
Suffix:
Gender:F
Credentials:NPCNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 CANDLER RD STE 14
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1415
Mailing Address - Country:US
Mailing Address - Phone:404-243-4433
Mailing Address - Fax:404-243-4449
Practice Address - Street 1:2855 CANDLER RD STE 14
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1415
Practice Address - Country:US
Practice Address - Phone:404-243-4433
Practice Address - Fax:404-243-4449
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN092866363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife