Provider Demographics
NPI:1629027743
Name:FATEMA, TAYABA (MD)
Entity Type:Individual
Prefix:
First Name:TAYABA
Middle Name:
Last Name:FATEMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAYABA
Other - Middle Name:
Other - Last Name:RASUL BANDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3305 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5483
Mailing Address - Country:US
Mailing Address - Phone:770-717-0033
Mailing Address - Fax:770-717-0028
Practice Address - Street 1:4775 JIMMY CARTER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-717-0033
Practice Address - Fax:770-806-0901
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics