Provider Demographics
NPI:1447639885
Name:AKHTAR, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5566 THOMASTON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-8118
Mailing Address - Country:US
Mailing Address - Phone:478-476-8868
Mailing Address - Fax:478-476-8868
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:MSC 143
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-0550
Practice Address - Fax:478-784-5496
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine