Healthcare Provider Details

I. General information

NPI: 1518541721
Provider Name (Legal Business Name): MUHAMMAD ALI RAZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

1086 FRANKLIN STREET, GME OFFICE, CONEMAUGH MEMORIAL E3-349 NANCY MARANO
JOHNSTOWN PA
15905
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5076
  • Fax:
Mailing address:
  • Phone: 814-534-9845
  • Fax: 814-534-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number99748
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT220118
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: