Healthcare Provider Details

I. General information

NPI: 1699701995
Provider Name (Legal Business Name): NAJAM SABREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RIVERSTONE DR
CANTON GA
30114-5256
US

IV. Provider business mailing address

PO BOX 2815
BLUE RIDGE GA
30513-0050
US

V. Phone/Fax

Practice location:
  • Phone: 770-720-2423
  • Fax: 877-430-2887
Mailing address:
  • Phone: 770-720-2423
  • Fax: 877-430-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number053602
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: