Individual
DR. SYEDA HEENA FATIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3945 LAWRENCEVILLE HWY NW # 29, LILBURN, GA 30047
(678) 380-8353
(678) 380-8388
Mailing address
3945 LAWRENCEVILLE HWY NW # 29, LILBURN, GA 30047-2817
(678) 380-8353
(678) 380-8388
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
065963
GA
207Q00000X
Family Medicine Physician
Primary
65963
GA
207Q00000X
Family Medicine Physician
L.2990
AL
208M00000X
Hospitalist Physician
065963
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0846248429
ADVANCED CARDIAC LIFE SUPPORT PROVIDER CERTIFICATION
GA
01
—
12268599
CAQH PROVIDER ID#
GA
01
—
202I081470
PTAN#
GA
01
—
65963
GA STATE LICENSE#
GA
Enumeration date
01/09/2009
Last updated
03/07/2023
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