Individual
MAIDA IMTIAZ AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
201 KIMBERLY WAY STE 200, CANTON, GA 30114-8010
(678) 381-2020
(678) 381-2015
Mailing address
1300 PEACHTREE INDUSTRIAL BLVD STE 1201, SUWANEE, GA 30024-4550
(678) 381-2020
(678) 381-2015
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003333
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT003333
PROFESSIONAL LICENSE
GA
Enumeration date
07/01/2021
Last updated
06/15/2022
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