Healthcare Provider Details

I. General information

NPI: 1083417497
Provider Name (Legal Business Name): ABDULMOIZ HATEM ABDULKAREEM AL-JAFARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

IV. Provider business mailing address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: