Individual
TASLIMA BHUIYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4120 FIVE FORKS TRICKUM RD SW, SUITE 103, LILBURN, GA 30047-3133
(770) 255-3491
(770) 255-3497
Mailing address
1468 MONTREAL RD, TUCKER, GA 30084-6901
(770) 638-1400
(770) 638-1411
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
071440
GA
207RC0000X
Cardiovascular Disease Physician
Primary
071440
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003145297B
—
GA
01
—
20206I9972
MEDICARE PTAN
GA
Enumeration date
06/14/2008
Last updated
10/02/2019
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