Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 066732 | GA |
NPI | 1033498118 |
---|---|
Provider Name | Dr. Syed Zia Ullah |
First Address | Suwanee, GA 30024-3257 |
Second Address | Decatur, GA 30033-3227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 08/08/2011 |