Provider Demographics
NPI:1710558788
Name:BASHIR, FARAH (MD)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:
Last Name:BASHIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2781
Mailing Address - Country:US
Mailing Address - Phone:719-584-4000
Mailing Address - Fax:
Practice Address - Street 1:350 COUNTRY CLUB DR STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9084
Practice Address - Country:US
Practice Address - Phone:678-289-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine