Provider Demographics
NPI:1760753776
Name:PERSAUD, BHEEM (CCT, CSA)
Entity Type:Individual
Prefix:MR
First Name:BHEEM
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:CCT, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-7354
Mailing Address - Country:US
Mailing Address - Phone:305-877-5319
Mailing Address - Fax:
Practice Address - Street 1:811 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-7354
Practice Address - Country:US
Practice Address - Phone:305-877-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3833246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist