=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417174186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUHAMMAD ALI PERVAIZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 HOSPITAL BLVD
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076-4915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-751-2777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 HOSPITAL BLVD
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076-4915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-751-2777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0201X
-----------------------------------------------------
Taxonomy Name | Clinical Genetics (M.D.) Physician
-----------------------------------------------------
License Number | 060549
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 50398-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 13465
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 060549
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207ZC0006X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology Physician
-----------------------------------------------------
License Number | 53443
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207ZC0006X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology Physician
-----------------------------------------------------
License Number | 105011
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 060549
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------