Provider Demographics
NPI:1255609350
Name:NAGI, BUTHENA AHMED (MD, MBCHB)
Entity type:Individual
Prefix:
First Name:BUTHENA
Middle Name:AHMED
Last Name:NAGI
Suffix:
Gender:F
Credentials:MD, MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HEMLOCK ST STE 220
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8311
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:478-741-7241
Practice Address - Street 1:2054 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3634
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:478-745-8932
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73352207R00000X
GA5385390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003160889Medicaid
GA003160889Medicaid