Healthcare Provider Details

I. General information

NPI: 1730195587
Provider Name (Legal Business Name): AZIZUL HOQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WELLBROOK CIR NE 103
CONYERS GA
30012-3825
US

IV. Provider business mailing address

1996 CLIFF VALLEY WAY NE 200
ATLANTA GA
30329-2449
US

V. Phone/Fax

Practice location:
  • Phone: 770-785-7112
  • Fax: 770-785-7115
Mailing address:
  • Phone: 404-636-9323
  • Fax: 404-320-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number49032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: