MEDICARE: DR. SINAN HADDAD 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	207Q00000X	Family Medicine Physician	056455	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	355208	OTHER	GA	WELLCARE
2	839618790A	OTHER	GA	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	904302	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528037033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SINAN HADDAD M.D.

Provider Business Mailing Address
First Line	:	1630 PLEASANT HILL RD STE 340
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5829
Country	:	US
Telephone Number	:	678-680-4290
Fax Number	:	678-680-4295

Provider Business Practice Location Address
First Line	:	1630 PLEASANT HILL RD STE 340
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5829
Country	:	US
Telephone Number	:	678-680-4290
Fax Number	:	678-680-4295

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/28/2020

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