Healthcare Provider Details

I. General information

NPI: 1124094875
Provider Name (Legal Business Name): MAHMOUD O JAWHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOSPITAL DR
GALAX VA
24333-2228
US

IV. Provider business mailing address

PO BOX 1337
GALAX VA
24333-1337
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-6906
  • Fax: 276-236-7179
Mailing address:
  • Phone: 276-236-3210
  • Fax: 276-236-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101-231348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: