Provider Demographics
NPI:1447497607
Name:FATIMA, SYEDA HEENA (MD)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:HEENA
Last Name:FATIMA
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 1:3945 LAWRENCEVILLE HWY NW # 29
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2817
Mailing Address - Country:US
Mailing Address - Phone:678-380-8353
Mailing Address - Fax:678-380-8388
Practice Address - Street 1:3945 LAWRENCEVILLE HWY NW # 29
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:678-380-8353
Practice Address - Fax:678-380-8388
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065963207P00000X, 208M00000X
ALL.2990207Q00000X
GA65963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0846248429OtherADVANCED CARDIAC LIFE SUPPORT PROVIDER CERTIFICATION
GA202I081470OtherPTAN#
GA12268599OtherCAQH PROVIDER ID#
GA65963OtherGA STATE LICENSE#
GA65963OtherGA STATE LICENSE#