Healthcare Provider Details

I. General information

NPI: 1063607109
Provider Name (Legal Business Name): DEVINA BHASIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW 77 BUILDING 5TH FLOOR
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW 77 BUILDING 5TH FLOOR
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2905
  • Fax: 678-244-6608
Mailing address:
  • Phone: 404-605-2905
  • Fax: 678-244-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number045626
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number045626
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number045626
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number68366
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: