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General NPI Number Information
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NPI Number | 1699974212
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Entity Type | Organization
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Legal Business Name | MEDICAL SPECIALTY ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2421 S MAIN ST
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City | MOULTRIE
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State | GA
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Zip | 31768-6531
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Country | US
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Telephone | 229-890-8474
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Fax | 229-890-5025
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Provider Business Mailing Address
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Address Line | 2421 S MAIN ST
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City | MOULTRIE
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State | GA
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Zip | 31768-6531
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Country | US
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Telephone | 229-890-8474
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Fax | 229-890-5025
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLO MAJID HATEM
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Credential | MD
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Telephone | 229-890-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 051425
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 051231
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License Number State | GA
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