Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 055150 | GA |
Y | 208600000X | Surgeon | 055150 | GA |
NPI | 1013003300 |
---|---|
Provider Name | Dr. Ahmad Ibn Nuriddin |
First Address | Stockbridge, GA 30281-9072 |
Second Address | Stockbridge, GA 30281-9072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 14/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
918927391B | (05) | GA |