Basic Information
| Provider Information | |||||||||
| NPI: | 1447313085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL-HAKIM | ||||||||
| FirstName: | AYMAN | ||||||||
| MiddleName: | SALAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702281767 | ||||||||
| FaxNumber: | 7702287562 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 S. 8TH STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702281767 | ||||||||
| FaxNumber: | 7702287562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 023012 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000234693Q | 05 | GA | MEDICAID | 202I835650 | 01 | GA | MEDICARE PTAN | OTHER | 000234693G | 05 | GA | MEDICAID | 000234693P | 05 | GA | MEDICAID |