Healthcare Provider Details

I. General information

NPI: 1619112042
Provider Name (Legal Business Name): MOHAMMED AIJAZ SHAREEF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 COLISEUM DR STE 120
MACON GA
31217-3859
US

IV. Provider business mailing address

1835 SAVOY DR STE 203
ATLANTA GA
30341-1073
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-6130
  • Fax:
Mailing address:
  • Phone: 770-496-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number102770
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number248829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: