MEDICARE: KARISHMA ALIBHAI

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	1223G0001X	General Practice Dentistry	DN123348	GA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114627973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISHMA ALIBHAI

Provider Business Mailing Address
First Line	:	831 MOUNT PARAN RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4545
Country	:	US
Telephone Number	:	404-937-9786
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 ROXBORO RD NE UNIT 4
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-7001
Country	:	US
Telephone Number	:	404-937-7860
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	04/09/2024

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