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General NPI Number Information
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NPI Number | 1174612477
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI AL AZEM M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3747 ROSWELL RD STE 215
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City | MARIETTA
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State | GA
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Zip | 30062-6228
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Country | US
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Telephone | 770-422-1372
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 403631
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City | ATLANTA
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State | GA
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Zip | 30384-3631
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Country | US
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Telephone | 770-740-0895
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Fax | 770-740-0896
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 41254
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 41254
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License Number State | GA
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