Provider Demographics
NPI:1235809948
Name:RAJA, AHMED MOHAMMEDNUR
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:MOHAMMEDNUR
Last Name:RAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 JAMIE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5218
Mailing Address - Country:US
Mailing Address - Phone:615-491-6995
Mailing Address - Fax:
Practice Address - Street 1:325 PLUS PARK BLVD STE 101-G
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1022
Practice Address - Country:US
Practice Address - Phone:615-975-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN095273084172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver