Provider Demographics
NPI:1760480727
Name:AFZAL, NADEEM (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:AFZAL
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 1:1109 MEDICAL CENTER DR
Mailing Address - Street 2:BUILDING #5
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6633
Mailing Address - Country:US
Mailing Address - Phone:706-863-6637
Mailing Address - Fax:706-863-6638
Practice Address - Street 1:1109 MEDICAL CENTER DR
Practice Address - Street 2:BUILDING #5
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6633
Practice Address - Country:US
Practice Address - Phone:706-863-6637
Practice Address - Fax:706-863-6638
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG90211Medicare UPIN
GA11SCCVNMedicare ID - Type UnspecifiedPROVIDER NUMBER