Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Mazen Shafiq Fakhouri, PA-C

Individual provider Surgical Physician Assistant · NPI 1205164217

Mr. Mazen Shafiq Fakhouri, PA-C is a Physician Assistant in Augusta, Georgia. Graduated from Medical College of Georgia School of Medicine in 2009, 17 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
17
Trained at
Medical College of Georgia School of Medicine
Licensed in
GA
In the registry since
2009
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1120 15th St Orthopaedic Clinic
Augusta, GA 30912-0004
Phone: (706) 721-2847
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 005712 (GA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 005712 (GA)

Record details

NPI number1205164217
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 2, 2009
Last updated in NPPESJanuary 18, 2024
Certification dateJanuary 18, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated 2009 (17 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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