Healthcare Provider Details

I. General information

NPI: 1558224188
Provider Name (Legal Business Name): AJAZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

600 RUE DAUPHINE
OCEAN SPRINGS MS
39564-3048
US

IV. Provider business mailing address

600 RUE DAUPHINE
OCEAN SPRINGS MS
39564-3048
US

V. Phone/Fax

Practice location:
  • Phone: 228-327-0706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM JUSTICE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 228-327-0706