Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | 064160 | GA |
NPI | 1184812968 |
---|---|
Provider Name | Dr. Mirsad Mujadzic |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GA1179 | (05) | SC |