Provider Demographics
NPI:1821137696
Name:FATTEH, HASANALI V (MD)
Entity Type:Individual
Prefix:
First Name:HASANALI
Middle Name:V
Last Name:FATTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1212 AUGUSTA WEST PKWY
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1808
Mailing Address - Country:US
Mailing Address - Phone:706-364-2020
Mailing Address - Fax:706-364-2022
Practice Address - Street 1:1212 AUGUSTA WEST PKWY
Practice Address - Street 2:SUITE A-1
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1808
Practice Address - Country:US
Practice Address - Phone:706-364-2020
Practice Address - Fax:706-364-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDFNVMedicare PIN