Healthcare Provider Details

I. General information

NPI: 1023646676
Provider Name (Legal Business Name): ALBAHI MALIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MICHAEL ST NE STE 205
ATLANTA GA
30322-2829
US

IV. Provider business mailing address

615 MICHAEL ST NE STE 205
ATLANTA GA
30322-2829
US

V. Phone/Fax

Practice location:
  • Phone: 929-278-7335
  • Fax: 404-712-2974
Mailing address:
  • Phone: 929-278-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0106579
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0106579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: