Individual
ATIA MBAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
6600 VAN AALST BLVD BLDG 9250, FORT BENNING, GA 31905-2102
(762) 408-0456
Mailing address
6714 BECK BLVD UNIT 22, COLUMBUS, GA 31904-3389
(210) 379-4058
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
RN162367
GA
363LF0000X
Family Nurse Practitioner
Primary
RN162367
GA
Other
Enumeration date
12/16/2016
Last updated
07/29/2025
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