Provider Demographics
NPI:1013019512
Name:MEWAR, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:MEWAR
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 1:2300 MANCHESTER EXPY STE 1001
Mailing Address - Street 2:BUTLER PAVILION
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6802
Mailing Address - Country:US
Mailing Address - Phone:706-322-0528
Mailing Address - Fax:706-322-2080
Practice Address - Street 1:2300 MANCHESTER EXPY STE 1001
Practice Address - Street 2:BUTLER PAVILION
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-0528
Practice Address - Fax:706-322-2080
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049064174400000X, 207RC0000X, 207RI0011X
AL23490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009985570OtherALABAMA MEDICAID
8566805-001OtherCIGNA PROVIDER NUMBER
GA814579OtherBCBS PROVIDER NUMBER
GA00878193AMedicaid
GA060062938OtherRAILROAD MEDICARE
AL009985570OtherALABAMA MEDICAID
GA814579OtherBCBS PROVIDER NUMBER