Healthcare Provider Details

I. General information

NPI: 1912969130
Provider Name (Legal Business Name): ALI AKHTER SHAIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WATSON BLVD HOUSTON MEDICAL CENTER, ATTN: RADIOLOGY DEPT
WARNER ROBINS GA
31093-3431
US

IV. Provider business mailing address

2929 WATSON BLVD STE 2 PMB 125
WARNER ROBINS GA
31093-9601
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-3603
  • Fax: 478-333-3685
Mailing address:
  • Phone: 478-333-3603
  • Fax: 478-333-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number056363
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number056363
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number056363
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number056363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: