Provider Demographics
NPI:1053508580
Name:HAFSA BELHARETH, SAMIRA (MD)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:HAFSA BELHARETH
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 1:5375 SUGARLOAF PKWY
Mailing Address - Street 2:12202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5767
Mailing Address - Country:US
Mailing Address - Phone:404-771-0652
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3157
Practice Address - Country:US
Practice Address - Phone:770-979-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics