Provider Demographics
NPI:1598990533
Name:HAKKY, TARIQ S (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:S
Last Name:HAKKY
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 1:371 E PACES FERRY ROAD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-400-3120
Mailing Address - Fax:404-481-2454
Practice Address - Street 1:371 E PACES FERRY ROAD
Practice Address - Street 2:SUITE 550
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-400-3120
Practice Address - Fax:404-481-2454
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology