Active NPI
Bushra Razzaque I, MD
- Forensic Psychiatry Physician
- Milledgeville, GA
National Provider Identifier
1689375156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychiatry Physician
- License
- 1196
- Practice address
- 620 Broad St
Milledgeville, GA 31062-7525 - Phone
- (858) 445-4128
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | 1196 | GA | Primary |
Addresses
Primary practice location
620 Broad St
Milledgeville, GA 31062-7525
Mailing address
620 Broad St
Milledgeville, GA 31062-7525
Phone (858) 445-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1196 | GA | MD | Forensic Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678665600000",
"number": "1689375156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 BROAD ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310627525",
"telephone_number": "858-445-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 BROAD ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310627525",
"telephone_number": "858-445-4128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAZZAQUE",
"first_name": "BUSHRA",
"name_prefix": "Dr.",
"name_suffix": "I",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-13",
"last_updated": "2023-03-13",
"certification_date": "2023-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "GA",
"license": "1196",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.