Provider Demographics
NPI:1154473593
Name:KASSAM, GULZAR BAHADURALI (MD)
Entity Type:Individual
Prefix:DR
First Name:GULZAR
Middle Name:BAHADURALI
Last Name:KASSAM
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 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:678-904-1150
Mailing Address - Fax:404-501-7713
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE# 1060
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-581-0307
Practice Address - Fax:404-501-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000118951FMedicaid
GA000118951GMedicaid
GAD29909Medicare UPIN