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NPI Code Detail

MEDICARE: DR. BAKHTIAR ALI M.D.

MEDICARE: DR. BAKHTIAR ALI M.D.
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
1207R00000XInternal Medicine Physician4301078954MI
2207RC0000XCardiovascular Disease Physician068877GA
3207RI0011XInterventional Cardiology Physician068877GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1068877OTHERGAGEROGIA LICENSE

General Provider Information

NPI Number : 1396767695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BAKHTIAR ALI M.D.
Provider Business Mailing Address
First Line : 1468 MONTREAL RD
Second Line :
City : TUCKER
State : GA
Zip : 30084-6901
Country : US
Telephone Number : 770-638-1400
Fax Number : 678-735-4685
Provider Business Practice Location Address
First Line : 1468 MONTREAL RD
Second Line :
City : TUCKER
State : GA
Zip : 30084-6901
Country : US
Telephone Number : 770-638-1400
Fax Number : 678-735-4685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 01/09/2013

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