Healthcare Provider Details

I. General information

NPI: 1013400407
Provider Name (Legal Business Name): SYED SAFDER ABBAS HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date: 01/25/2019
Reactivation Date: 05/08/2019

III. Provider practice location address

800 S MAIN ST
JONESBORO AR
72401-3548
US

IV. Provider business mailing address

1364 CLIFTON ROAD, NE OFFICE OF SURGICAL EDUCATION, SUITE H100
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-7024
  • Fax:
Mailing address:
  • Phone: 404-727-0093
  • Fax: 404-712-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberE-19376
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: