Healthcare Provider Details

I. General information

NPI: 1851229579
Provider Name (Legal Business Name): MAJAAZUDDIN MOHAMMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4500 13TH STREET PO BOX 1810
GULFPORT MS
39501
US

IV. Provider business mailing address

4500 13TH STREET PO BOX 1810
GULFPORT MS
39501
US

V. Phone/Fax

Practice location:
  • Phone: 228-822-6512
  • Fax: 228-575-1937
Mailing address:
  • Phone: 228-822-6512
  • Fax: 228-575-1937

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: