Healthcare Provider Details

I. General information

NPI: 1598949679
Provider Name (Legal Business Name): BAHAIR HUSSEIN GHAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2007
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 870
ATLANTA GA
30342-5029
US

IV. Provider business mailing address

5361 REYNOLDS ST
SAVANNAH GA
31405-6014
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2975
  • Fax: 404-255-2276
Mailing address:
  • Phone: 404-931-4915
  • Fax: 912-355-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number60174
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number060174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: