Provider Demographics
NPI:1346046505
Name:RAHMAN, MD MAHBUBUR
Entity type:Individual
Prefix:
First Name:MD MAHBUBUR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 ARBOR GATE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8809
Mailing Address - Country:US
Mailing Address - Phone:404-940-5586
Mailing Address - Fax:
Practice Address - Street 1:129 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2304
Practice Address - Country:US
Practice Address - Phone:770-479-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPH035281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist