Provider Demographics
NPI:1497957088
Name:RAHMAN, HASAN M HAFIZUR (MD)
Entity Type:Individual
Prefix:
First Name:HASAN
Middle Name:M HAFIZUR
Last Name:RAHMAN
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 1:1070 PEARL MIST DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5495
Mailing Address - Country:US
Mailing Address - Phone:315-528-6608
Mailing Address - Fax:
Practice Address - Street 1:4151 MEMORIAL DR
Practice Address - Street 2:ASSERTIVE COMMUNITY RECOVERY
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1504
Practice Address - Country:US
Practice Address - Phone:404-508-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA650492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65049Medicaid