Healthcare Provider Details

I. General information

NPI: 1205521861
Provider Name (Legal Business Name): AZAZ UMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 FIRST BLVD
HERMITAGE TN
37076
US

IV. Provider business mailing address

2008 DAYLILY DR
FRANKLIN TN
37067-8608
US

V. Phone/Fax

Practice location:
  • Phone: 615-316-3000
  • Fax:
Mailing address:
  • Phone: 703-638-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5151016159
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: