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General NPI Number Information
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NPI Number | 1053508580
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Entity Type | Individual
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Provider Name | SAMIRA HAFSA BELHARETH M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 2800 MAIN ST W
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City | SNELLVILLE
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State | GA
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Zip | 30078-3157
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Country | US
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Telephone | 770-979-7213
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Fax |
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Provider Business Mailing Address
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Address Line | 5375 SUGARLOAF PKWY 12202
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5767
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Country | US
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Telephone | 404-771-0652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 060078
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License Number State | GA
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