Provider Demographics
NPI:1235302415
Name:KAZIMI, MARWAN MUJID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:MUJID
Last Name:KAZIMI
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 1:1365 CLIFTON RD NE BLDG B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:855-366-7989
Mailing Address - Fax:404-712-2617
Practice Address - Street 1:1365 CLIFTON RD NE BLDG B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-5501
Practice Address - Country:US
Practice Address - Phone:855-366-7989
Practice Address - Fax:404-712-2617
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA290089208600000X
GA074439204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABK9975876OtherDEA