MEDICARE: GENERAL PRACTICE M HAKIMA MD PC

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	207Q00000X	Family Medicine Physician	12420	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1687649592	OTHER	AL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1811063399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL PRACTICE M HAKIMA MD PC

Provider Business Mailing Address
First Line	:	PO BOX 1911
Second Line	:
City	:	FLOMATON
State	:	AL
Zip	:	36441-1911
Country	:	US
Telephone Number	:	251-296-0136
Fax Number	:	251-296-1916

Provider Business Practice Location Address
First Line	:	1831 ROOSEVELT STREET
Second Line	:	PO DRAWER 1911
City	:	FLOMATON
State	:	AL
Zip	:	36441-1911
Country	:	US
Telephone Number	:	251-296-0136
Fax Number	:	251-296-1916

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	M HAKIMA
Credential	:	MD
Telephone Number	:	251-296-0136

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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