Individual
FARID AHMAD IDRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 PEACHBROOK WAY, LAWRENCEVILLE, GA 30043-2361
(470) 418-4998
Mailing address
333 PEACHBROOK WAY, LAWRENCEVILLE, GA 30043-2361
(470) 418-4998
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
059898067
GA
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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