Provider Demographics
NPI:1043311459
Name:TEJANI, NIZAR ALI (MD)
Entity Type:Individual
Prefix:
First Name:NIZAR
Middle Name:ALI
Last Name:TEJANI
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 1:1004 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-507-9929
Mailing Address - Fax:770-507-9930
Practice Address - Street 1:1004 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-507-9929
Practice Address - Fax:770-507-9930
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036302207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000526666BMedicaid
GA000526666BMedicaid
GA44ZCBKGMedicare PIN