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NPI Code Detail

MEDICARE: KOMAL EJAZ M.D.

MEDICARE: KOMAL EJAZ M.D.
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
1207R00000XInternal Medicine Physician99527GA
2207RR0500XRheumatology Physician99527GA

General Provider Information

NPI Number : 1518522598
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOMAL EJAZ M.D.
Provider Business Mailing Address
First Line : 1270 PRINCE AVE STE 303
Second Line :
City : ATHENS
State : GA
Zip : 30606-2783
Country : US
Telephone Number : 706-475-7055
Fax Number :
Provider Business Practice Location Address
First Line : 1270 PRINCE AVE STE 303
Second Line :
City : ATHENS
State : GA
Zip : 30606-2783
Country : US
Telephone Number : 706-475-7055
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2019
Last Update Date : 07/29/2024

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Directions to “ KOMAL EJAZ M.D.” Practice Location

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