Provider Demographics
NPI:1699973511
Name:NIA, FARSHID HAMIDI (DMD, MSD)
Entity type:Individual
Prefix:
First Name:FARSHID
Middle Name:HAMIDI
Last Name:NIA
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PROMINENCE POINT PKWY
Mailing Address - Street 2:SUITE- 500
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9108
Mailing Address - Country:US
Mailing Address - Phone:770-479-9999
Mailing Address - Fax:770-479-9990
Practice Address - Street 1:150 PROMINENCE POINT PKWY
Practice Address - Street 2:SUITE- 500
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9108
Practice Address - Country:US
Practice Address - Phone:770-479-9999
Practice Address - Fax:770-479-9990
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336497403OtherNIA DENTISTRY LLC