Provider Demographics
NPI:1124038526
Name:MCHEZAJI, TAYARI (MD)
Entity Type:Individual
Prefix:
First Name:TAYARI
Middle Name:
Last Name:MCHEZAJI
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 1:2313 NORBURY CV SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5206
Mailing Address - Country:US
Mailing Address - Phone:404-729-6925
Mailing Address - Fax:
Practice Address - Street 1:235 PEACHTREE ST NE
Practice Address - Street 2:SUITE 2100, NORTH TOWER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1401
Practice Address - Country:US
Practice Address - Phone:770-994-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050409207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000918057GOtherGA URGENT CARE MCAID ID
GA511I930107OtherGA URGENT CARE MCARE ID
GAH44357Medicare UPIN