MEDICARE: DR. AZMI M TAWADROS D.D.S.,M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	034726	GA

General Provider Information

NPI Number	:	1043252851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZMI M TAWADROS D.D.S.,M.D.

Provider Business Mailing Address
First Line	:	5283 BELLS FERRY RD
Second Line	:	SUITE 200
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	770-516-7153
Fax Number	:	770-516-4826

Provider Business Practice Location Address
First Line	:	5283 BELLS FERRY RD
Second Line	:	SUITE 200
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	770-516-7153
Fax Number	:	770-516-4826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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