Organization
SHIRAZ HABIB KASSAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MUBINA MAWJI (OFFICE MANAGER)
(770) 922-2424
Entity
Organization
Contact information
Practice address
1380 MILSTEAD AVE NE, CONYERS, GA 30012-3864
(770) 922-2424
(770) 922-8782
Mailing address
1380 MILSTEAD AVE NE, CONYERS, GA 30012-3864
(770) 922-2424
(770) 922-8782
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
21321
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000190506B
—
GA
Enumeration date
02/17/2012
Last updated
02/17/2012
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