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Individual
O AKHRAS
Active
Individual
O AKHRAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
020504
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100168
PEACHSTATE
GA
01
—
10040031
AMERIGROUP
GA
01
—
480588
BLUE CROSS
GA
Enumeration date
08/05/2006
Last updated
03/18/2008
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