Provider Demographics
NPI:1538294889
Name:OZA, DUSHYANT (MD)
Entity Type:Individual
Prefix:MR
First Name:DUSHYANT
Middle Name:
Last Name:OZA
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:P.O. BOX 2216
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604
Mailing Address - Country:US
Mailing Address - Phone:229-241-0059
Mailing Address - Fax:229-241-2088
Practice Address - Street 1:2501 NORTH PATTERSON STREET
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-241-0059
Practice Address - Fax:229-241-2088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA344912080N0001X
GA71976208M00000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344910Medicaid
CA00A344910Medicare ID - Type Unspecified
CA00A344910Medicaid