MEDICARE: MAHAM EJAZ MD

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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1487599056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHAM EJAZ MD

Provider Business Mailing Address
First Line	:	5001 HARDY ST
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402
Country	:	US
Telephone Number	:	601-296-3963
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 HARDY ST
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402
Country	:	US
Telephone Number	:	601-296-3963
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ MAHAM EJAZ MD” Practice Location

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