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General NPI Number Information
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NPI Number | 1285881201
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Entity Type | Individual
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Provider Name | JAWAD SHEQWARA M.D
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Gender | Male
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 1706 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5216
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Country | US
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Telephone | 912-490-4673
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Fax | 912-490-4674
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Provider Business Mailing Address
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Address Line | 1900 TEBEAU ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6357
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Country | US
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Telephone | 912-490-4673
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Fax | 912-490-4674
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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 | 4301092099
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 071285
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License Number State | GA
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