Healthcare Provider Details

I. General information

NPI: 1396853826
Provider Name (Legal Business Name): MUNEER AL-HAKIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SPARTA HWY
EATONTON GA
31024-8484
US

IV. Provider business mailing address

PO BOX 3009
EATONTON GA
31024-3009
US

V. Phone/Fax

Practice location:
  • Phone: 706-923-0904
  • Fax: 706-923-0905
Mailing address:
  • Phone: 478-452-3835
  • Fax: 478-295-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number042781
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: