Provider Demographics
NPI:1760554703
Name:BHAMANI, ANWER ALI SHAMSUDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:ANWER ALI
Middle Name:SHAMSUDDIN
Last Name:BHAMANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 SAINT IVES COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2001
Mailing Address - Country:US
Mailing Address - Phone:770-880-1774
Mailing Address - Fax:770-502-6754
Practice Address - Street 1:1364 CLIFTON RD NE STE N-305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-6342
Practice Address - Country:US
Practice Address - Phone:404-778-5334
Practice Address - Fax:404-778-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA639911800AMedicaid