Healthcare Provider Details

I. General information

NPI: 1619862240
Provider Name (Legal Business Name): MODERNA SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 MORRIS RD STE B
ALPHARETTA GA
30005-4137
US

IV. Provider business mailing address

12425 MORRIS RD STE B
ALPHARETTA GA
30005-4137
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2975
  • Fax:
Mailing address:
  • Phone: 404-255-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BAHAIR GHAZI
Title or Position: OWNER/ PRESIDENT
Credential: MD
Phone: 404-931-4915