Healthcare Provider Details

I. General information

NPI: 1043252851
Provider Name (Legal Business Name): AZMI M TAWADROS D.D.S.,M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5283 BELLS FERRY RD SUITE 200
ACWORTH GA
30102-2500
US

IV. Provider business mailing address

5283 BELLS FERRY RD SUITE 200
ACWORTH GA
30102-2500
US

V. Phone/Fax

Practice location:
  • Phone: 770-516-7153
  • Fax: 770-516-4826
Mailing address:
  • Phone: 770-516-7153
  • Fax: 770-516-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: