Healthcare Provider Details

I. General information

NPI: 1932213154
Provider Name (Legal Business Name): TASNEEM H BHATIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DRESDEN DR NE
BROOKHAVEN GA
30319-3579
US

IV. Provider business mailing address

1401 DRESDEN DR NE
BROOKHAVEN GA
30319-3579
US

V. Phone/Fax

Practice location:
  • Phone: 404-814-9808
  • Fax:
Mailing address:
  • Phone: 404-814-9808
  • Fax: 404-814-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberBB6785109
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number049025
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: