Healthcare Provider Details

I. General information

NPI: 1053336461
Provider Name (Legal Business Name): WILLIAM ALOIS FAJMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

2860 HAWTHORNE DR NE
ATLANTA GA
30345-1347
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-9729
  • Fax:
Mailing address:
  • Phone: 770-934-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: