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General NPI Number Information
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NPI Number | 1942263678
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Entity Type | Individual
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Provider Name | SOHAIL EJAZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 663 LANIER PARK DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-2059
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Country | US
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Telephone | 678-450-0202
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Fax | 678-971-6065
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Provider Business Mailing Address
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Address Line | PO BOX 740209 DEPARTMENT 40233
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City | ATLANTA
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State | GA
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Zip | 30374-0209
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Country | US
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Telephone | 678-450-0202
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Fax | 678-450-0080
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 060065
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License Number State | GA
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