1679890552 NPI number — BAHATI HARDEN MD

Table of content: BAHATI HARDEN MD (NPI 1679890552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679890552 NPI number — BAHATI HARDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDEN
Provider First Name:
BAHATI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679890552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 RIVER RD
Provider Second Line Business Mailing Address:
P.O. BOX 1410
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38930-4030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-459-7285
Provider Business Mailing Address Fax Number:
662-459-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PROFESSIONAL PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38930-9633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-451-7881
Provider Business Practice Location Address Fax Number:
662-451-7865
Provider Enumeration Date:
04/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  22836 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD205764 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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