Healthcare Provider Details

I. General information

NPI: 1821269887
Provider Name (Legal Business Name): EHTESHAMUL HAQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 ARMOUR RD SUITE A-4
COLUMBUS GA
31904-5296
US

IV. Provider business mailing address

4820 ARMOUR RD SUITE A-4
COLUMBUS GA
31904-5296
US

V. Phone/Fax

Practice location:
  • Phone: 706-649-7676
  • Fax: 706-649-5497
Mailing address:
  • Phone: 706-649-7676
  • Fax: 706-649-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: