Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 042296 | GA |
NPI | 1003849027 |
---|---|
Provider Name | Ghulam Mustafa Jarwar |
First Address | Conyers, GA 30013-9441 |
Second Address | Conyers, GA 30013-2974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 27/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00726415J | (05) | GA |
43563G | (02) |