Healthcare Provider Details

I. General information

NPI: 1235059460
Provider Name (Legal Business Name): SYED AZEEM HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 LANEY WALKER BLVD
AUGUSTA GA
30912-0002
US

IV. Provider business mailing address

190 OAKBROOK DRIVE
NORTH AUGUSTA SC
29860
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone: 904-806-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number113999
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: