Healthcare Provider Details

I. General information

NPI: 1861874661
Provider Name (Legal Business Name): AHSAN AKHTAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-9666
  • Fax:
Mailing address:
  • Phone: 859-323-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number114523
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number51330
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: