Provider Demographics
NPI:1184801276
Name:BAKARI, DASHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:DASHAWN
Middle Name:
Last Name:BAKARI
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:PO BOX 190306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31119-0306
Mailing Address - Country:US
Mailing Address - Phone:770-477-1115
Mailing Address - Fax:770-477-1119
Practice Address - Street 1:6584 PROFESSIONAL PL
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4942
Practice Address - Country:US
Practice Address - Phone:770-477-1115
Practice Address - Fax:770-477-1119
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2257208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27-0821510OtherTRICARE
GA9065421OtherAETNA
GA52463639-003OtherBLUE CROSS BLUE SHIELD
GA032883905CMedicaid
GA9752079OtherCIGNA
GA3094116OtherUNITED HEALTHCARE