Individual
DR. ALFRED WALTER MAZUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 DOCTORS DR, SUITE 220, DOUGLAS, GA 31533-2201
(912) 384-4030
(912) 384-4039
Mailing address
PO BOX 1377, DOUGLAS, GA 31534-1377
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
046695
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000833412D
—
GA
05
—
000833412E
—
GA
01
—
046695
PHYSICIAN LICENSE #
GA
01
—
11D1092458
CLIA ID - 200 DOCTORS DR STE 220
GA
01
—
11D1105865
CLIA ID - 17 JOHNSON ST
GA
01
—
477420
WELLCARE
GA
01
—
DH1281
RAILROAD MEDICARE - GROUP #
GA
01
—
P00726011
RAILROAD MEDICARE - PTAN
GA
Enumeration date
01/20/2006
Last updated
03/07/2023
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