MEDICARE: DR. AHMAD UMAIR JANJUA 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	208D00000X	General Practice Physician	79564	GA
2	390200000X	Student in an Organized Health Care Education/Training Program		NJ
3	2084P0800X	Psychiatry Physician	79564	GA

General Provider Information

NPI Number	:	1588027973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD UMAIR JANJUA M.D.

Provider Business Mailing Address
First Line	:	445 WINN WAY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4216
Country	:	US
Telephone Number	:	404-618-1854
Fax Number	:

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

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	01/12/2023

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