Basic Information
| Provider Information | |||||||||
| NPI: | 1184852600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZAM | ||||||||
| FirstName: | NOSHEEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 173 | ||||||||
| Address2: | |||||||||
| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315020173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124900722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 BEACON ST | ||||||||
| Address2: | |||||||||
| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315017104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067213157 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 003585 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.