Provider Demographics
NPI:1679575443
Name:AZMAT, NAJAM (MD)
Entity Type:Individual
Prefix:
First Name:NAJAM
Middle Name:
Last Name:AZMAT
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 1:707 CONFEDERATE WAY
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9490
Mailing Address - Country:US
Mailing Address - Phone:912-338-9796
Mailing Address - Fax:
Practice Address - Street 1:707 CONFEDERATE WAY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-9490
Practice Address - Country:US
Practice Address - Phone:912-338-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-02-18
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
GA0565122086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA749349931AMedicaid
GAG38624Medicare UPIN
GA749349931AMedicaid