Basic Information
| Provider Information | |||||||||
| NPI: | 1376745109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAITIEH | ||||||||
| FirstName: | BASHAR | ||||||||
| MiddleName: | SAMIH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 MICHAEL ST NE | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047128286 | ||||||||
| FaxNumber: | 4047128227 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 MICHAEL ST NE | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047128286 | ||||||||
| FaxNumber: | 4047128227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 066080 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 066080 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 066080 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.