MEDICARE: DR. DASHAWN BAKARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	2257	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27-0821510	OTHER	GA	TRICARE
2	9065421	OTHER	GA	AETNA
3	52463639-003	OTHER	GA	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	9752079	OTHER	GA	CIGNA
6	3094116	OTHER	GA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1184801276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DASHAWN BAKARI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31119-0306
Country	:	US
Telephone Number	:	770-477-1115
Fax Number	:	770-477-1119

Provider Business Practice Location Address
First Line	:	6584 PROFESSIONAL PL
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4942
Country	:	US
Telephone Number	:	770-477-1115
Fax Number	:	770-477-1119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	05/04/2016

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