Healthcare Provider Details

I. General information

NPI: 1801499686
Provider Name (Legal Business Name): TAMEEM Q BADWAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OAK ST
BOWDON GA
30108-1412
US

IV. Provider business mailing address

100 OAK ST
BOWDON GA
30108-1412
US

V. Phone/Fax

Practice location:
  • Phone: 770-258-2487
  • Fax:
Mailing address:
  • Phone: 770-258-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023339
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031766
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: