Provider Demographics
NPI:1396186714
Name:IMAM, MAJD (DDS)
Entity type:Individual
Prefix:MR
First Name:MAJD
Middle Name:
Last Name:IMAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-0850
Mailing Address - Country:US
Mailing Address - Phone:706-449-8352
Mailing Address - Fax:706-449-8005
Practice Address - Street 1:150-160 NORTH LOUISVILLE STREET
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:GA
Practice Address - Zip Code:30814-5084
Practice Address - Country:US
Practice Address - Phone:706-449-8352
Practice Address - Fax:706-449-8005
Is Sole Proprietor?:No
Enumeration Date:2013-07-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29293122300000X
GADN122909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist