Healthcare Provider Details

I. General information

NPI: 1366370769
Provider Name (Legal Business Name): MUHAMMAD WAQAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 LANEY WALKER BLVD
AUGUSTA GA
30912-7310
US

IV. Provider business mailing address

600 MARSHALL ST UNIT 303
LOUISVILLE KY
40202-3685
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone: 502-202-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number113122
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: