Provider Demographics
NPI:1376745109
Name:STAITIEH, BASHAR SAMIH (MD)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:SAMIH
Last Name:STAITIEH
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 1:615 MICHAEL ST NE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1047
Mailing Address - Country:US
Mailing Address - Phone:404-712-8286
Mailing Address - Fax:404-712-8227
Practice Address - Street 1:615 MICHAEL ST NE
Practice Address - Street 2:SUITE 211
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1047
Practice Address - Country:US
Practice Address - Phone:404-712-8286
Practice Address - Fax:404-712-8227
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA066080207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine