Provider Demographics
NPI:1023082005
Name:HAFEEZ, ABDUL (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:HAFEEZ
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 1:721 WELLNESS WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3304
Mailing Address - Country:US
Mailing Address - Phone:770-682-2500
Mailing Address - Fax:770-682-2014
Practice Address - Street 1:721 WELLNESS WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3304
Practice Address - Country:US
Practice Address - Phone:770-682-2500
Practice Address - Fax:770-682-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47327207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189665601Medicaid
GA00837416AMedicaid
TX189665601Medicaid
GAG29338Medicare UPIN
GA07BBSTKMedicare Oscar/Certification