Provider Demographics
NPI:1003074212
Name:HASSAN, AHAD MANZOOR UL (MD)
Entity Type:Individual
Prefix:DR
First Name:AHAD
Middle Name:MANZOOR UL
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 JOE RAMSEY BLVD E STE 130
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7830
Mailing Address - Country:US
Mailing Address - Phone:903-201-6688
Mailing Address - Fax:
Practice Address - Street 1:1411 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2673
Practice Address - Country:US
Practice Address - Phone:706-272-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2260207RI0011X
390200000X
TXP8032207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program