Active NPI
Maryam Riaz
- Medical Physician Assistant
- Watkinsville, GA
National Provider Identifier
1912620790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 12575
- Practice address
- 1160 Capital Ave Ste 105
Watkinsville, GA 30677-1832 - Phone
- (706) 946-4041
- NPI assigned
- Sep 26, 2022
- Last updated
- May 5, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 12575 | GA | Primary |
Addresses
Primary practice location
1160 Capital Ave Ste 105
Watkinsville, GA 30677-1832
Mailing address
PO Box 459
Colbert, GA 30628-0459
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Emory University School of Medicine, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1160 Capital Ave
Suite 105
Watkinsville, GA 30677-1832
Phone (706) 521-3113
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12575 | GA | MD | Medical Physician Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Colbert, GA
- NPI 1396794541
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777939200000",
"number": "1912620790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 459",
"city": "COLBERT",
"state": "GA",
"postal_code": "306280459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 CAPITAL AVE STE 105",
"city": "WATKINSVILLE",
"state": "GA",
"postal_code": "306771832",
"telephone_number": "706-946-4041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIAZ",
"first_name": "MARYAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2026-05-05",
"certification_date": "2026-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "GA",
"license": "12575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watkinsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.