Provider Demographics
NPI:1043493547
Name:GULZAR B. KASSAM, MD, P.C.
Entity type:Organization
Organization Name:GULZAR B. KASSAM, MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-904-1150
Mailing Address - Street 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:678-904-1150
Mailing Address - Fax:404-501-7713
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 255
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:678-904-1150
Practice Address - Fax:404-501-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty