Provider Demographics
NPI:1174785828
Name:FATTEH, NADEEM H (MD)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:H
Last Name:FATTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 AUGUSTA WEST PKWY
Mailing Address - Street 2:STE A-1
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1808
Mailing Address - Country:US
Mailing Address - Phone:706-364-2020
Mailing Address - Fax:706-364-2022
Practice Address - Street 1:1212 AUGUSTA WEST PKWY
Practice Address - Street 2:STE A-1
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1808
Practice Address - Country:US
Practice Address - Phone:706-364-2020
Practice Address - Fax:706-364-2022
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003117207R00000X
MI4301100014207W00000X
GA70104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102I180831Medicare PIN
MI0P30630865Medicare PIN