MEDICARE: MR. MAJD IMAM D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	29293	TX
2	122300000X	Dentist	DN122909	GA

General Provider Information

NPI Number	:	1396186714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAJD IMAM D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-0850
Country	:	US
Telephone Number	:	706-449-8352
Fax Number	:	706-449-8005

Provider Business Practice Location Address
First Line	:	150-160 NORTH LOUISVILLE STREET
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-5084
Country	:	US
Telephone Number	:	706-449-8352
Fax Number	:	706-449-8005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2013
Last Update Date	:	02/06/2023

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