Individual
MARIUM MUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1900 TEBEAU ST, WAYCROSS, GA 31501-6357
(267) 570-7526
Mailing address
2601 HOLME AVE, PHILADELPHIA, PA 19152-2007
(267) 350-7403
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
90105
GA
390200000X
Student in an Organized Health Care Education/Training Program
MT219263
PA
Other
Enumeration date
06/30/2019
Last updated
05/11/2022
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