Provider Demographics
NPI:1720223415
Name:CHOWDHURY, MORIUM
Entity type:Individual
Prefix:
First Name:MORIUM
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 AUTUMN BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7432
Mailing Address - Country:US
Mailing Address - Phone:678-437-1659
Mailing Address - Fax:
Practice Address - Street 1:4652 LAWRENCEVILLE HWY NW STE 104
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3623
Practice Address - Country:US
Practice Address - Phone:678-437-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51162207P00000X
KS0449744207P00000X, 207Q00000X
TXT7518207P00000X
GA94276207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine