Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 060549 | GA |
NPI | 1417174186 |
---|---|
Provider Name | Muhammad Ali Pervaiz |
First Address | Douglasville, GA 30134-2272 |
Second Address | Roswell, GA 30076-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 11/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30207035 | (05) | NH |