Provider Demographics
NPI:1982783304
Name:MUMTAZ MUMTAZ INC
Entity Type:Organization
Organization Name:MUMTAZ MUMTAZ INC
Other - Org Name:ALPHARETTA ROSWELL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-640-8814
Mailing Address - Street 1:2404 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6343
Mailing Address - Country:US
Mailing Address - Phone:770-640-8814
Mailing Address - Fax:770-640-8815
Practice Address - Street 1:2404 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6343
Practice Address - Country:US
Practice Address - Phone:770-640-8814
Practice Address - Fax:770-640-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty