MEDICARE: NAYYER U ISLAM 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	2085R0202X	Diagnostic Radiology Physician	055603	GA

General Provider Information

NPI Number	:	1750361697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAYYER U ISLAM MD

Provider Business Mailing Address
First Line	:	1416 FALKIRK LN NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-8299
Country	:	US
Telephone Number	:	770-462-3460
Fax Number	:	770-727-0809

Provider Business Practice Location Address
First Line	:	2230 TOWNE LAKE PARKWAY
Second Line	:	BLDG, NO. 900, SUITE 250 & 150
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5540
Country	:	US
Telephone Number	:	404-556-9222
Fax Number	:	404-556-9222

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/12/2017

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