Provider Demographics
NPI:1700938123
Name:FARISI, HAZIM A (MD)
Entity type:Individual
Prefix:DR
First Name:HAZIM
Middle Name:A
Last Name:FARISI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4965 FRIENDSHIP RD
Mailing Address - Street 2:ST 103
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1700
Mailing Address - Country:US
Mailing Address - Phone:678-714-5692
Mailing Address - Fax:678-714-5693
Practice Address - Street 1:4965 FRIENDSHIP RD
Practice Address - Street 2:ST 103
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1700
Practice Address - Country:US
Practice Address - Phone:678-714-5692
Practice Address - Fax:678-714-5693
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA016201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00457168CMedicaid
GA08BBWXCMedicare PIN
GA00457168CMedicaid