Provider Demographics
NPI:1518612647
Name:HAKIM, TIMOTHY (MS, CGC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:HAKIM
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 BERKFORD CT NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1707
Mailing Address - Country:US
Mailing Address - Phone:928-978-5435
Mailing Address - Fax:
Practice Address - Street 1:1100 JOHNSON FY RD NE STE 350
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1740
Practice Address - Country:US
Practice Address - Phone:404-851-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA480170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480OtherGENETIC COUNSELOR LICENSE
20193OtherABGC: CERTIFIED GENETIC COUNSELOR AND DIPLOMATE