Individual
FAHEEM B NUSRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1021 SILVER BLUFF RD, AIKEN, SC 29803
(803) 648-0587
(803) 648-9846
Mailing address
UNIVERSITY MEDICAL GROUP, P O BOX 1705, AUGUSTA, GA 30903-1705
(706) 774-7261
(706) 774-7279
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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