Provider Demographics
NPI:1962799734
Name:MUBARAK ALI, FARAH (MD)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MUBARAK ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 CRABAPPLE RD
Mailing Address - Street 2:104 B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2489
Mailing Address - Country:US
Mailing Address - Phone:770-645-0017
Mailing Address - Fax:770-645-0224
Practice Address - Street 1:11050 CRABAPPLE RD
Practice Address - Street 2:104 B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2489
Practice Address - Country:US
Practice Address - Phone:770-645-0017
Practice Address - Fax:770-645-0224
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005288207Q00000X
GA72373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine