Healthcare Provider Details

I. General information

NPI: 1821039637
Provider Name (Legal Business Name): SALMAN BASEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 TREES OF KENNESAW PARKWAY
KENNESAW GA
30152-7658
US

IV. Provider business mailing address

1401 TREES OF KENNESAW PKWY NW
KENNESAW GA
30152-7658
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-8583
  • Fax:
Mailing address:
  • Phone: 516-503-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301088018
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number059121
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number059121
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: