Provider Demographics
NPI:1063474088
Name:NAJAM AZMAT, M. D., P. C.
Entity Type:Organization
Organization Name:NAJAM AZMAT, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAJAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMAT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:912-338-9796
Mailing Address - Street 1:707 CONFEDERATE WAY
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9490
Mailing Address - Country:US
Mailing Address - Phone:912-338-9796
Mailing Address - Fax:
Practice Address - Street 1:707 CONFEDERATE WAY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-9490
Practice Address - Country:US
Practice Address - Phone:912-338-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0565122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA749349931AMedicaid
GA056512OtherSTATE LICENSE NUMBER
GA77BBBMXMedicare PIN
GAG38624Medicare UPIN