Healthcare Provider Details

I. General information

NPI: 1588824346
Provider Name (Legal Business Name): TASLIMA BHUIYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 FIVE FORKS TRICKUM RD SW SUITE 103
LILBURN GA
30047-3133
US

IV. Provider business mailing address

1468 MONTREAL RD
TUCKER GA
30084-6901
US

V. Phone/Fax

Practice location:
  • Phone: 770-255-3491
  • Fax: 770-255-3497
Mailing address:
  • Phone: 770-638-1400
  • Fax: 770-638-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number071440
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number071440
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: