Provider Demographics
NPI:1336494624
Name:ARA, ANJUM (MD)
Entity Type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:ARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1499 WALTON WAY STE 1400
Mailing Address - Street 2:ATTN: D. RAIFORD
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-828-8401
Mailing Address - Fax:706-722-7235
Practice Address - Street 1:997 SAINT SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-2613
Practice Address - Country:US
Practice Address - Phone:706-721-6597
Practice Address - Fax:706-721-6602
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2017-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0753672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166444BMedicaid