Healthcare Provider Details

I. General information

NPI: 1417174186
Provider Name (Legal Business Name): MUHAMMAD ALI PERVAIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HOSPITAL BLVD
ROSWELL GA
30076-4915
US

IV. Provider business mailing address

3000 HOSPITAL BLVD
ROSWELL GA
30076-4915
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-2777
  • Fax:
Mailing address:
  • Phone: 770-751-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number060549
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50398-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13465
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number060549
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number53443
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number105011
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number060549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: