Basic Information
| Provider Information | |||||||||
| NPI: | 1104833698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESKANDAR | ||||||||
| FirstName: | NIZAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15849 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314162549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033552 | ||||||||
| FaxNumber: | 9123033506 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 S MAIN ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | HINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313134353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128776822 | ||||||||
| FaxNumber: | 9124086781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 047425 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 047425 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RN0300X | 047425 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 000879062F | 05 | GA | MEDICAID | P00689897 | 01 | GA | RR | OTHER | 000879062G | 05 | GA | MEDICAID | Q47425 | 05 | SC | MEDICAID |