MEDICARE: DR. ADEL BAGH 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
1	174400000X	Specialist	017038	GA

General Provider Information

NPI Number	:	1942292164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEL BAGH M.D.

Provider Business Mailing Address
First Line	:	35 COLLIER RD NW
Second Line	:	SUITE 475
City	:	ATLANTA
State	:	GA
Zip	:	30309-1613
Country	:	US
Telephone Number	:	404-351-7900
Fax Number	:	404-351-7901

Provider Business Practice Location Address
First Line	:	35 COLLIER RD NW
Second Line	:	SUITE 475
City	:	ATLANTA
State	:	GA
Zip	:	30309-1613
Country	:	US
Telephone Number	:	404-351-7900
Fax Number	:	404-351-7901

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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