Individual provider Active NPI

Beesan Shalabi Agha, DO

  • Pediatrics Physician
  • Atlanta, GA
National Provider Identifier
1285896647
Registry record updated Mar 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
66558 Issued in GA
Practice address
1645 Tullie Cir NE
Atlanta, GA 30329-2304
Phone
(708) 945-3948
NPI assigned
Jun 27, 2008
Last updated
Mar 26, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 66558 GA Primary

Addresses

Primary practice location

1645 Tullie Cir NE
Atlanta, GA 30329-2304

Mailing address

1645 Tullie Cir NE
Atlanta, GA 30329-2304

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150422001114 GA Practitioner - Pediatric Medicine 1254550080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Practice addresses (Care Compare)

1200 Memorial Dr
Dalton, GA 30720-2529
Phone (706) 278-2105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage, LLC CurrentSince Jan 1, 2015 Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

1001 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 785-2008

Interoperability endpoints

  • Direct secure messaging: bagha44294@choa.gadirect.net

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332720000000",
    "number": "1285896647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 TULLIE CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292304",
            "telephone_number": "708-945-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGHA",
        "first_name": "BEESAN",
        "middle_name": "SHALABI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-27",
        "last_updated": "2012-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "66558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.