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General NPI Number Information
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NPI Number | 1659347102
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Entity Type | Individual
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Provider Name | TAREK BISAT MD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 1062 FORSYTH ST STE 210
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City | MACON
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State | GA
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Zip | 31201-8637
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Country | US
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Telephone | 478-633-8391
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Fax | 478-633-8395
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Provider Business Mailing Address
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Address Line | 1062 FORSYTH ST STE 210
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City | MACON
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State | GA
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Zip | 31201-8637
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Country | US
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Telephone | 478-633-8391
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Fax | 478-633-8395
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 030954
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License Number State | GA
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