Provider Demographics
NPI:1619026150
Name:BOGHANI, HANIF (MD)
Entity Type:Individual
Prefix:
First Name:HANIF
Middle Name:
Last Name:BOGHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:HANIF
Other - Last Name:MOHAMMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 467071
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31146-7071
Mailing Address - Country:US
Mailing Address - Phone:770-939-2020
Mailing Address - Fax:770-939-6688
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 214
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-939-2020
Practice Address - Fax:770-939-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047929174400000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA435309113AMedicaid
GA435309113AMedicaid
GAF70575Medicare UPIN