Provider Demographics
NPI:1750361697
Name:ISLAM, NAYYER U (MD)
Entity type:Individual
Prefix:
First Name:NAYYER
Middle Name:U
Last Name:ISLAM
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 1:1416 FALKIRK LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8299
Mailing Address - Country:US
Mailing Address - Phone:770-462-3460
Mailing Address - Fax:770-727-0809
Practice Address - Street 1:2230 TOWNE LAKE PARKWAY
Practice Address - Street 2:BLDG, NO. 900, SUITE 250 & 150
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:404-556-9222
Practice Address - Fax:404-556-9222
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0556032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI21759Medicare UPIN
GA30BDNFXMedicare PIN