Individual provider Active NPI

Ali Mirza, MD, MPH

  • Internal Medicine Physician
  • Augusta, GA
National Provider Identifier
1114769478
Registry record updated Jun 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16491 Issued in GA
Practice address
1459 Laney Walker Blvd
Augusta, GA 30912-0002
Phone
(706) 721-0345
NPI assigned
Jun 8, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16491 GA Primary

Addresses

Primary practice location

1459 Laney Walker Blvd
Augusta, GA 30912-0002

Mailing address

636 11TH St Apt 2211
Augusta, GA 30901-2189
Phone (803) 629-2343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240809000948 GA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8123565017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16491GAMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717804800000",
    "number": "1114769478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 11TH ST APT 2211",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012189",
            "telephone_number": "803-629-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1459 LANEY WALKER BLVD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120002",
            "telephone_number": "706-721-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-08",
        "last_updated": "2024-06-08",
        "certification_date": "2024-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "16491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.