Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 21321 | GA |
Y | 207VG0400X | Gynecologist | 21321 | GA |
N | 207VX0000X | Obstetrician | 21321 | GA |
NPI | 1265401020 |
---|---|
Provider Name | Dr. Shiraz Habib Kassam |
First Address | Conyers, GA 30012-3864 |
Second Address | Conyers, GA 30012-3864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000190506B | (05) | GA |
D29907 | (02) | GA |