Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036302 | GA |
Y | 111NI0900X | Internist | 036302 | GA |
N | 207RI0200X | Infectious Disease | 036302 | GA |
NPI | 1043311459 |
---|---|
Provider Name | Nizar Ali Tejani |
First Address | Stockbridge, GA 30281 |
Second Address | Stockbridge, GA 30281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 27/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000526666B | (05) | GA |
F45813 | (02) |