Provider Demographics
NPI:1437105046
Name:NISAR, AZHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AZHAR
Middle Name:
Last Name:NISAR
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 1:1407 CHATTANOOGA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2631
Mailing Address - Country:US
Mailing Address - Phone:706-279-0470
Mailing Address - Fax:706-279-1758
Practice Address - Street 1:1407 CHATTANOOGA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2631
Practice Address - Country:US
Practice Address - Phone:706-279-0470
Practice Address - Fax:706-279-1758
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG42375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG52995Medicare UPIN