Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 061941 | GA |
N | 207Q00000X | Family Doctor | RTP 1193 | GA |
N | 207QS0010X | Family Doctor - Sports Medicine | RTP 1193 | GA |
NPI | 1215155692 |
---|---|
Provider Name | Dr. Michael Romani Bakheet |
First Address | Atlanta, GA 30305-1717 |
Second Address | Duluth, GA 30096-4506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 07/01/2022 |