Individual provider Active NPI

Irtiqa Farooq Fazili, MD

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1679159024
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
99985 Issued in GA
Practice address
1364 Clifton Rd NE
Atlanta, GA 30322-3049
Phone
(404) 778-7777
NPI assigned
Mar 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 99985 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Atlanta, GA 30322-3049

Mailing address

49 Jesse Hill Jr Dr SE Ste 491
Atlanta, GA 30303-5807
Phone (404) 251-8778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240909001168 GA Practitioner - Internal MedicinePractitioner - Hospitalist 9234534884 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
99985GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc Internal Medicine CurrentSince Jul 26, 2024 Accepting new patients
The Emory Clinic Inc Internal Medicine CurrentSince Jul 26, 2024 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Jul 26, 2024 Accepting new patients
Emory Health Care Past Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

49 Jesse Hill Jr Dr SE
Ste 491
Atlanta, GA 30303
Phone (404) 251-8778

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1679159024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 JESSE HILL JR DR SE STE 491",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303035807",
            "telephone_number": "404-251-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303223049",
            "telephone_number": "404-778-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZILI",
        "first_name": "IRTIQA",
        "middle_name": "FAROOQ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "99985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.