Basic Information
| Provider Information | |||||||||
| NPI: | 1295781094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | FAKHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 PACES FERRY RD SE STE 1-1100 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303396151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064755076 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064755076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 043840 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 043840 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | 043840 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | G43840 | 05 | SC | MEDICAID | 000796254K | 05 | GA | MEDICAID | BA5360641 | 01 | GA | DEA # | OTHER |