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Individual
FAHEEM B NUSRAT
Active
Individual
FAHEEM B NUSRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD38409
SC
207R00000X
Internal Medicine Physician
044043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000471809A
MEDICAID FQHC
GA
05
—
000471809B
—
GA
05
—
000788081B
—
GA
05
—
000788081E
—
GA
01
—
10057307
AMERIGROUP
GA
01
—
111811
MEDICARE FQHC
GA
01
—
111812
MEDICARE FQHC
GA
01
—
111814
MEDICARE FQHC
GA
01
—
11SCCWT
MEDICARE FFS
GA
01
—
341628
WELLCARE
GA
01
—
341629
WELLCARE
GA
01
—
341630
WELLCARE
GA
01
—
342410
WELLCARE
GA
01
—
GRP1619
MEDICARE FFS GROUP
GA
01
—
P00015170
MEDICARE RR RETIRED
—
Enumeration date
08/17/2005
Last updated
07/12/2018
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