1801078001 NPI number — HAZIM A. FARISI MD PC

Table of content: (NPI 1801078001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801078001 NPI number — HAZIM A. FARISI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAZIM A. FARISI MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRIENDSHIP CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801078001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4965 FRIENDSHIP RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BUFORD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30518-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-714-5692
Provider Business Mailing Address Fax Number:
678-714-5693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4965 FRIENDSHIP RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BUFORD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-714-5692
Provider Business Practice Location Address Fax Number:
678-714-5693
Provider Enumeration Date:
11/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FARISI
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
678-714-5692

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  016201 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700938123 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00457168C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP4668 . This is a "GROUP PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1801078001 . This is a "GROUP NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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