Provider Demographics
NPI:1003849027
Name:JARWAR, GHULAM MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:MUSTAFA
Last Name:JARWAR
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:PO BOX 82746
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9441
Mailing Address - Country:US
Mailing Address - Phone:770-922-0553
Mailing Address - Fax:770-922-6882
Practice Address - Street 1:2020 HONEY CREEK PKWY SE
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2974
Practice Address - Country:US
Practice Address - Phone:770-922-0553
Practice Address - Fax:770-922-6882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00726415JMedicaid
GA00726415JMedicaid
43563GMedicare UPIN