Provider Demographics
NPI:1699974212
Name:MEDICAL SPECIALTY ASSOCIATES, INC.
Entity type:Organization
Organization Name:MEDICAL SPECIALTY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:MAJID
Authorized Official - Last Name:HATEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-890-8474
Mailing Address - Street 1:2421 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6531
Mailing Address - Country:US
Mailing Address - Phone:229-890-8474
Mailing Address - Fax:229-890-5025
Practice Address - Street 1:2421 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6531
Practice Address - Country:US
Practice Address - Phone:229-890-8474
Practice Address - Fax:229-890-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051425207RH0003X
GA051231207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty