Shiraz Habib Kassam, M.D.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

21321 Issued in GA

Practice address

1380 Milstead Ave NE Ste B
Conyers, GA 30012-3864

Phone

(770) 922-2424

Fax

(770) 922-8782

NPI assigned

Mar 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shiraz Habib Kassam

  • Obstetrics Physician
  • Conyers, GA
  • NPI 1295008563
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265401020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 MILSTEAD AVE NE STE B",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123864",
            "telephone_number": "770-922-2424",
            "fax_number": "770-922-8782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 MILSTEAD AVE NE STE B",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123864",
            "telephone_number": "770-922-2424",
            "fax_number": "770-922-8782"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1309 Milstead Rd NE",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300123874",
            "country_code": "US",
            "telephone_number": "770-922-2424",
            "fax_number": "770-922-8782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASSAM",
        "first_name": "SHIRAZ",
        "middle_name": "HABIB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "21321",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "21321",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "GA",
            "license": "21321",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000190506B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gynecology Physician in Conyers, GA
• Providers in Conyers, GA by specialty
• Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.