Provider Demographics
NPI:1932194719
Name:HUMAYUN, NASEER AHMAD (MD)
Entity type:Individual
Prefix:
First Name:NASEER
Middle Name:AHMAD
Last Name:HUMAYUN
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 1:1420 MINERAL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5354
Mailing Address - Country:US
Mailing Address - Phone:706-226-2330
Mailing Address - Fax:706-226-2340
Practice Address - Street 1:1420 MINERAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5354
Practice Address - Country:US
Practice Address - Phone:706-226-2330
Practice Address - Fax:706-226-2340
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052583207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA720395713AMedicaid
GA720395713AMedicaid
GA11BDWRQMedicare ID - Type Unspecified