Tayyab Fayyaz Bhutta, M.D.
Individual provider Active NPI Emergency Medicine Physician · Milledgeville, GA
NPI 1063503233 · NPPES record last updated Nov 4, 2013
Key facts
- NPI
- 1063503233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 048335 (GA)
- Practice address
- 1850 N Columbia St
Suite 3
Milledgeville, GA 31061-2385 - Phone
- (478) 453-4101
- Fax
- (478) 453-4105
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Hospital Authority of Monroe County, Georgia | Past | Accepting new patients | |
| Douglas Internal Medicine P.C. | Past | Accepting new patients | |
| Acs Primary Care Physicians - Southeast PC | Emergency Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 048335 | GA | |
| Emergency Medicine Physician | 207P00000X | 048335 | GA | Yes |
Addresses
Primary practice location
1850 N Columbia St
Suite 3
Milledgeville, GA 31061-2385
Mailing address
311 Wimbledon Court
Macon, GA 31211
Phone (478) 742-7949
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00850957A | Medicaid | GA |
Other providers in Milledgeville, GA
- Robin Beavers
- Claudia Hope Bell
- Wendy Arlene Bell
- Kayla Bennett
- Theresa Betts
- Bio-Medical Applications of Georgia, Inc.
- Kandace Danielle Bivens
- Jaimie Lynn Blackwell
- Madilyn Harrington Blizzard
- Parker Rhett Blizzard
All providers in Milledgeville, GA · Emergency Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.