Provider Demographics
NPI:1376632307
Name:AZAR, GEORGE JAMES III (M D)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
Last Name:AZAR
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 FAIRFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1588
Mailing Address - Country:US
Mailing Address - Phone:601-450-2401
Mailing Address - Fax:601-450-2410
Practice Address - Street 1:139 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1303
Practice Address - Country:US
Practice Address - Phone:601-450-2401
Practice Address - Fax:601-450-2410
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15260208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118119Medicaid
F75124Medicare UPIN
MS020000326Medicare PIN