Afsheen Siddique, MD | |
6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905-2102 | |
(762) 408-0374 | |
Not Available |
Full Name | Afsheen Siddique |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 6600 Van Aalst Blvd Bldg 9250, Fort Moore, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1235380593 | NPI | - | NPPES |
20414 | Other | MS | MISSISSIPPI MEDICAL LICENSE |
07372301 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 20414 (Mississippi) | Secondary |
208000000X | Pediatrics | 34287 (Alabama) | Secondary |
208000000X | Pediatrics | 80234 (ZZ) | Primary |
Entity Name | St Francis Physician Practices Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1326749417 PECOS PAC ID: 8729381033 Enrollment ID: O20160120002073 |
Mailing Address | Practice Location Address |
---|---|
Afsheen Siddique, MD 2300 Manchester Expy Ste 2001a, Columbus, GA 31904-6802 Ph: (706) 320-3126 | Afsheen Siddique, MD 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905-2102 Ph: (762) 408-0374 |
Graeme Philip Bloomfield, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 6600 Van Aalst Blvd, Fort Moore, GA 31905 Phone: 660-031-9057 | |
Brittany Bumgardner, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905 Phone: 762-408-2273 | |
Ayesha Mejia Nettles, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6600 Van Aalst Blvd Bldg 9250, Fort Moore, GA 31905 Phone: 762-408-2273 Fax: 762-408-8101 |