MEDICARE: DR. DEVINA BHASIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	045626	CT
2	208M00000X	Hospitalist Physician	045626	CT
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	045626	CT
4	207RT0003X	Transplant Hepatology Physician	68366	GA

General Provider Information

NPI Number	:	1063607109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVINA BHASIN MD

Provider Business Mailing Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:	77 BUILDING 5TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-605-2905
Fax Number	:	678-244-6608

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:	77 BUILDING 5TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-605-2905
Fax Number	:	678-244-6608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	02/06/2014

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