Individual
SHIREEN HAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1266 HIGHWAY 515 S, JASPER, GA 30143-4872
(706) 301-5434
(706) 301-5438
Mailing address
1300 RIDENOUR BLVD NW STE 300, KENNESAW, GA 30152-4402
(707) 702-1806
(707) 693-0801
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101252856
VA
207L00000X
Anesthesiology Physician
201100645
NC
207L00000X
Anesthesiology Physician
Primary
73579
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000744
—
LA
05
—
1306036934
—
VA
05
—
5918210
—
NC
05
—
NC1473
—
SC
05
—
NC1944A
—
NC
Enumeration date
07/30/2007
Last updated
12/29/2021
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