Provider Demographics
NPI: | 1235318056 |
---|---|
Name: | BOURJI, NAJI (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | NAJI |
Middle Name: | |
Last Name: | BOURJI |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 17 CENTRE PLAZA DR |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSON |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38305-2862 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 731-512-0104 |
Mailing Address - Fax: | 731-668-7388 |
Practice Address - Street 1: | 17 CENTRE PLAZA DR |
Practice Address - Street 2: | |
Practice Address - City: | JACKSON |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38305-2862 |
Practice Address - Country: | US |
Practice Address - Phone: | 731-512-0104 |
Practice Address - Fax: | 731-668-7388 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-10-29 |
Last Update Date: | 2023-10-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 51438 | 207RI0011X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 1396033379 | Other | NPI |
TN | 103I112090 | Other | MEDICARE |
TN | Q006578 | Medicaid |