Active NPI
Fakhra Tehreem Sultan, MD
- Internal Medicine Physician
- Augusta, GA
National Provider Identifier
1124758347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 13822
- Practice address
- 1120 15TH St
Augusta, GA 30912-0004 - Phone
- (706) 721-2273
- NPI assigned
- Jun 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 13822 | GA | Primary |
Addresses
Primary practice location
1120 15TH St
Augusta, GA 30912-0004
Mailing address
380 Connor Cir
Evans, GA 30809-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13822 | Other | GA | GEORIGA COMPOSITE MEDICAL BOARD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | fsultan@augusta.edu | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220712003786 | GA | Order and Referring Only - Internal Medicine | 3870974579 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13822 | GA | MD | Physician Assistant |
Interoperability endpoints
- fsultan222943@ummc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654905600000",
"number": "1124758347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 CONNOR CIR",
"city": "EVANS",
"state": "GA",
"postal_code": "308096100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "706-721-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULTAN",
"first_name": "FAKHRA",
"middle_name": "TEHREEM",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-11",
"last_updated": "2022-06-11",
"certification_date": "2022-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "13822",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORIGA COMPOSITE MEDICAL BOARD",
"identifier": "13822",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "fsultan@augusta.edu",
"affiliation": "N",
"endpointDescription": "Email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1120 15th St",
"city": "Augusta",
"state": "GA",
"country_code": "US",
"postal_code": "309120004",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.