MEDICARE: BC COLLECTIVE OF GA LLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1700746237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BC COLLECTIVE OF GA LLC

Provider Business Mailing Address
First Line	:	133 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-2904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE R
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	302-463-1527
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SABA HAQ
Credential	:	MD
Telephone Number	:	949-463-0650

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	12/01/2025

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