Provider Demographics
NPI:1588824346
Name:BHUIYAN, TASLIMA (MD)
Entity Type:Individual
Prefix:
First Name:TASLIMA
Middle Name:
Last Name:BHUIYAN
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 1:1468 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6901
Mailing Address - Country:US
Mailing Address - Phone:770-638-1400
Mailing Address - Fax:770-638-1411
Practice Address - Street 1:4120 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 103
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3133
Practice Address - Country:US
Practice Address - Phone:770-255-3491
Practice Address - Fax:770-255-3497
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071440207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20206I9972OtherMEDICARE PTAN
GA003145297BMedicaid
GA20206I9972Medicare PIN