Provider Demographics
NPI:1679890552
Name:HARDEN, BAHATI (MD)
Entity Type:Individual
Prefix:
First Name:BAHATI
Middle Name:
Last Name:HARDEN
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 1:1401 RIVER RD
Mailing Address - Street 2:P.O. BOX 1410
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4030
Mailing Address - Country:US
Mailing Address - Phone:662-459-7285
Mailing Address - Fax:662-459-1147
Practice Address - Street 1:102 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-9633
Practice Address - Country:US
Practice Address - Phone:662-451-7881
Practice Address - Fax:662-451-7865
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205764207Q00000X
MS22836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine