Basic Information
| Provider Information | |||||||||
| NPI: | 1134324395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAZACK | ||||||||
| FirstName: | RAZVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7229 WHEAT ST NE | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300141566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786255132 | ||||||||
| FaxNumber: | 6786255137 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404548193 | ||||||||
| FaxNumber: | 7404541470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 71859 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 003153742A | 05 | GA | MEDICAID | 0224440 | 05 | OH | MEDICAID |