Provider Demographics
NPI:1699941286
Name:MALIK, FARHAN JAVED (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:JAVED
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 HOLCOMB BRIDGE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6868
Mailing Address - Country:US
Mailing Address - Phone:770-416-9995
Mailing Address - Fax:
Practice Address - Street 1:8460 HOLCOMB BRIDGE RD FL 2
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6868
Practice Address - Country:US
Practice Address - Phone:770-416-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12677207Q00000X
KY42980207QS0010X
GA66215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000625044OtherANTHEM
KYP00752408OtherRAILROAD
KY7100082420Medicaid
KY7100082420Medicaid