Healthcare Provider Details

I. General information

NPI: 1245142546
Provider Name (Legal Business Name): MAZEN ABOUKAMAR BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GORDON HWY
GROVETOWN GA
30813-3808
US

IV. Provider business mailing address

1007 IRIS GLEN DR
EVANS GA
30809-9301
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-4700
  • Fax:
Mailing address:
  • Phone: 706-951-4170
  • 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: