Provider Demographics
NPI:1770558611
Name:BAKRI, YOUNES N (MD)
Entity type:Individual
Prefix:
First Name:YOUNES
Middle Name:N
Last Name:BAKRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOUNES
Other - Middle Name:N
Other - Last Name:EL-BAKRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:840 PINE ST
Mailing Address - Street 2:STE 760
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2100
Mailing Address - Country:US
Mailing Address - Phone:478-633-6090
Mailing Address - Fax:478-633-2175
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:STE 760
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2100
Practice Address - Country:US
Practice Address - Phone:478-633-6090
Practice Address - Fax:478-633-2175
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072289207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104552746Medicaid
GA072289OtherGA LICENSE
MI104552746Medicaid
MIN66660006Medicare PIN