Provider Demographics
NPI:1306975651
Name:KAJANI, MIRZA A (MD)
Entity type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:A
Last Name:KAJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:226 E COLLEGE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4348
Mailing Address - Country:US
Mailing Address - Phone:678-987-1490
Mailing Address - Fax:678-987-1491
Practice Address - Street 1:226 E COLLEGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4348
Practice Address - Country:US
Practice Address - Phone:678-987-1490
Practice Address - Fax:678-987-1491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA31955207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300052394OtherTAX I.D. FOR OTHER INSURA
GA000403147AMedicaid
GA102I100129OtherPTAN
GA202I100956OtherPTAN
GA202I100956OtherPTAN