Provider Demographics
NPI:1063583680
Name:REHAN, MUHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:REHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2805
Mailing Address - Country:US
Mailing Address - Phone:478-745-7696
Mailing Address - Fax:478-745-6440
Practice Address - Street 1:640 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2805
Practice Address - Country:US
Practice Address - Phone:478-745-7696
Practice Address - Fax:478-745-6440
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000758172NMedicaid
GA110238633OtherRAIL ROAD MEDICARE
GA52597384 011OtherBCBS PROVIDER #
GA000758172NOtherPEACH STATE PROVIDER #
GA319589OtherWELL CARE PROVIDER #
GA319589OtherWELL CARE PROVIDER #