Provider Demographics
NPI:1619862240
Name:MODERNA SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:MODERNA SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-931-4915
Mailing Address - Street 1:12425 MORRIS RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4137
Mailing Address - Country:US
Mailing Address - Phone:404-255-2975
Mailing Address - Fax:
Practice Address - Street 1:12425 MORRIS RD STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4137
Practice Address - Country:US
Practice Address - Phone:404-255-2975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty