1821070830 NPI number — DR. KARIM GANI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821070830 NPI number — DR. KARIM GANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANI
Provider First Name:
KARIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1821070830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 HOSPITAL SOUTH DR
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106-6810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-741-5000
Provider Business Mailing Address Fax Number:
770-944-4492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 RIVERSTONE TER
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-741-2317
Provider Business Practice Location Address Fax Number:
678-741-2301
Provider Enumeration Date:
11/16/2005

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: 207RG0100X , with the licence number:  046761 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00836239A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202I109321 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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