Provider Demographics
NPI:1548444748
Name:NIZAR A. TEJANI MD. PC
Entity type:Organization
Organization Name:NIZAR A. TEJANI MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:770-507-9929
Mailing Address - Street 1:1004 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7384
Mailing Address - Country:US
Mailing Address - Phone:770-507-9929
Mailing Address - Fax:770-507-9930
Practice Address - Street 1:1004 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7384
Practice Address - Country:US
Practice Address - Phone:770-507-9929
Practice Address - Fax:770-507-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00526666BMedicaid
GAGRP6140Medicare PIN