Provider Demographics
NPI:1467694216
Name:BASHIR, RIZWAN (MD)
Entity type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:
Last Name:BASHIR
Suffix:
Gender:
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 569
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-0569
Mailing Address - Country:US
Mailing Address - Phone:770-678-7024
Mailing Address - Fax:770-678-7025
Practice Address - Street 1:2009 LAWRENCEVILLE SUWANEE RD STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2612
Practice Address - Country:US
Practice Address - Phone:770-678-7024
Practice Address - Fax:770-678-7025
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA696842084N0400X
GA0696842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology