Provider Demographics
NPI:1821070830
Name:GANI, KARIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIM
Middle Name:
Last Name:GANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6810
Mailing Address - Country:US
Mailing Address - Phone:678-741-5000
Mailing Address - Fax:770-944-4492
Practice Address - Street 1:145 RIVERSTONE TER
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5317
Practice Address - Country:US
Practice Address - Phone:678-741-2317
Practice Address - Fax:678-741-2301
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA046761207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00836239AMedicaid
GA202I109321OtherMEDICARE PTAN
GA00836239AMedicaid
G13474Medicare UPIN