1194708651 NPI number — DR. RANA RAB HASAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194708651 NPI number — DR. RANA RAB HASAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HASAN

Provider First Name:

RANA

Provider Middle Name:

RAB

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

RAB

Provider Other First Name:

RANA

Provider Other Middle Name:

IMAM

Provider Other Name Prefix Text:

DR.

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1194708651

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/14/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1664 MULKEY RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

AUSTELL

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30106-1114

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

770-422-1372

Provider Business Mailing Address Fax Number:

770-999-2599

Provider First Line Business Practice Location Address:

4441 ATLANTA RD SE STE 214

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SMYRNA

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30080-6442

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

470-956-4150

Provider Business Practice Location Address Fax Number:

678-842-5536

Provider Enumeration Date:

11/29/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  029291 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RS0012X , with the licence number: 029291 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: 029291 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0932200001 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 2423197008 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4800059 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 450162 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 290010952 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 2999759 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: 00557862B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1194708651 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 5934 . This is a "KAISER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 5235111 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".