Healthcare Provider Details

I. General information

NPI: 1659347102
Provider Name (Legal Business Name): TAREK BISAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST STE 210
MACON GA
31201-8637
US

IV. Provider business mailing address

1062 FORSYTH ST STE 210
MACON GA
31201-8637
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-8391
  • Fax: 478-633-8395
Mailing address:
  • Phone: 478-633-8391
  • Fax: 478-633-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number030954
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: