Provider Demographics
NPI:1972605418
Name:HASAN, SYED SAJID (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SAJID
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 SPIVEY STATION BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2886
Mailing Address - Country:US
Mailing Address - Phone:678-782-5000
Mailing Address - Fax:678-289-9448
Practice Address - Street 1:7823 SPIVEY STATION BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2886
Practice Address - Country:US
Practice Address - Phone:678-782-5000
Practice Address - Fax:678-289-9448
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0557572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526873369CMedicaid
GAI26064Medicare ID - Type Unspecified