Provider Demographics
NPI:1093762502
Name:BUTT, AWAIS IJAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:AWAIS
Middle Name:IJAZ
Last Name:BUTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 FAIRBURN RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2915
Mailing Address - Country:US
Mailing Address - Phone:770-783-1799
Mailing Address - Fax:770-573-0559
Practice Address - Street 1:2971 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2915
Practice Address - Country:US
Practice Address - Phone:770-783-1799
Practice Address - Fax:770-573-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV04883Medicare UPIN
GA35ZCJFFMedicare ID - Type Unspecified