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General NPI Number Information
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NPI Number | 1326017906
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Entity Type | Individual
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Provider Name | BOB B BAGHERI M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 204 CANTON RD
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City | CUMMING
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State | GA
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Zip | 30040-2304
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Country | US
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Telephone | 770-886-5437
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Fax | 770-886-5437
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Provider Business Mailing Address
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Address Line | 11565 MOUNTAIN LAUREL DR
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City | ROSWELL
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State | GA
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Zip | 30075-1333
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Country | US
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Telephone | 770-886-5437
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Fax | 770-886-9717
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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 | 040865
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License Number State | GA
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