MEDICARE: JAWAID KAMAL 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	207P00000X	Emergency Medicine Physician	26915	TN
2	207R00000X	Internal Medicine Physician	26915	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4093112	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1538131073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAID KAMAL MD

Provider Business Mailing Address
First Line	:	854 W JAMES CAMPBELL BLVD
Second Line	:	SUITE 303
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4659
Country	:	US
Telephone Number	:	931-540-4255
Fax Number	:	931-796-6203

Provider Business Practice Location Address
First Line	:	617 W MAIN ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462-1355
Country	:	US
Telephone Number	:	931-796-4901
Fax Number	:	931-796-6203

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	04/28/2021

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Directions to “ JAWAID KAMAL MD” Practice Location

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