Provider Demographics
NPI:1699913905
Name:BULBUL, MOHMAD AJAZ UL-HAQ (MD)
Entity type:Individual
Prefix:DR
First Name:MOHMAD AJAZ
Middle Name:UL-HAQ
Last Name:BULBUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHMAD AJAZ
Other - Middle Name:UL-HAQ
Other - Last Name:BULBUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:912-819-4646
Mailing Address - Fax:912-819-4667
Practice Address - Street 1:455 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4354
Practice Address - Country:US
Practice Address - Phone:912-819-4646
Practice Address - Fax:912-819-4667
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0091207RH0003X
CAA106208207R00000X
GA87015207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003240502AMedicaid
NM14130351Medicaid
NM19321870448OtherGROUP NPI
NM800521089OtherMCR GROUP
NM000Z2565OtherMEDICAID GROUP
NMCH3451OtherRAILROAD MEDICARE GROUP
NMP01121731OtherMEDICARE RAILROAD CARRIER
NMCH3451OtherRAILROAD MEDICARE GROUP