Basic Information
| Provider Information | |||||||||
| NPI: | 1932167624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEHATA | ||||||||
| FirstName: | BAHIG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 CLIFTON RD NE | ||||||||
| Address2: | EGLESTON CHILDRENS HOSPITAL | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047856499 | ||||||||
| FaxNumber: | 4047851370 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 BEAUBIEN ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455315 | ||||||||
| FaxNumber: | 3139938754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207ZP0101X | 050760 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0213X | 050760 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology |
No ID Information.