Individual
ISHAQ SAYYID MUMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 E CROSSVILLE RD, ROSWELL, GA 30075-5816
(470) 704-5086
Mailing address
419 E CROSSVILLE RD, ROSWELL, GA 30075-5816
(470) 704-5086
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1416
GA
Other
Enumeration date
08/05/2022
Last updated
08/05/2022
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