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Individual

MR. MAZEN SHAFIQ FAKHOURI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1120 15TH ST, ORTHOPAEDIC CLINIC, AUGUSTA, GA 30912-0004
(706) 721-2847
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005712
GA
363AS0400X
Surgical Physician Assistant
005712
GA

Other

Enumeration date
12/02/2009
Last updated
01/18/2024
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