Healthcare Provider Details

I. General information

NPI: 1396181434
Provider Name (Legal Business Name): MAIRAJ TARIQ SAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JESSE JEWELL PKWY NE STE 300
GAINESVILLE GA
30501-3875
US

IV. Provider business mailing address

UNIVERSITY OF KANSAS HOSP DEPT OF 3901 RAINBOW BLVD MS 3021
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-6520
  • Fax:
Mailing address:
  • Phone: 913-588-6119
  • Fax: 913-588-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number86319
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number94-08118
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: