Provider Demographics
NPI:1457347296
Name:SAFDAR, NABILE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:NABILE
Middle Name:
Last Name:SAFDAR
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1060
Mailing Address - Country:US
Mailing Address - Phone:404-785-6541
Mailing Address - Fax:404-785-1248
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-6541
Practice Address - Fax:404-785-1248
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA725862085R0202X
DCMD0386112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKC46SH 60340002OtherCAREFIRST
DC3811 0068OtherCAREFIRST BCBS
MD110800000 405319200Medicaid
MD865LI581Medicare PIN
MD545L N065Medicare PIN
MDKC46SH 60340002OtherCAREFIRST
MDH380I580Medicare PIN