Provider Demographics
NPI:1396853826
Name:AL-HAKIM, MUNEER (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNEER
Middle Name:
Last Name:AL-HAKIM
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:PO BOX 3009
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-3009
Mailing Address - Country:US
Mailing Address - Phone:706-923-0904
Mailing Address - Fax:706-923-0905
Practice Address - Street 1:116 SPARTA HWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-8484
Practice Address - Country:US
Practice Address - Phone:706-923-0904
Practice Address - Fax:706-923-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0427812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA297003OtherWELLCARE
GA611384188AMedicaid
GA913725245AMedicaid
GA000739296CMedicaid
GA000739296COtherPEACH STATE HEALTH PLAN
GA000739296DOtherPEACH STATE HEALTH PLAN
GA10033063OtherAMERIGROUP
GA297026OtherWELLCARE
GA58-2624216OtherTAX IDENTIFICATION NUMBER
GA166056OtherBLUE CROSS BLUE SHIELD
GA000739296DMedicaid