Provider Demographics
NPI:1386945491
Name:SYAH, LLC
Entity type:Organization
Organization Name:SYAH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-532-0800
Mailing Address - Street 1:1250 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3865
Mailing Address - Country:US
Mailing Address - Phone:770-532-0800
Mailing Address - Fax:770-532-0801
Practice Address - Street 1:4205 MUNDY MILL PL
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2566
Practice Address - Country:US
Practice Address - Phone:770-532-0800
Practice Address - Fax:770-532-0835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYAH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7705Medicare PIN