Provider Demographics
NPI:1144470840
Name:AHMED, SYED ABUZAR WASEEM
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:ABUZAR WASEEM
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4131
Mailing Address - Country:US
Mailing Address - Phone:706-812-2369
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:1602 VERNON RD STE 400
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4129
Practice Address - Country:US
Practice Address - Phone:706-882-9341
Practice Address - Fax:706-884-0131
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011103207R00000X, 208M00000X
GA070332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist