Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 015331 | GA |
N | 2080P0208X | Pediatric Infectious Diseases | 015331 | GA |
NPI | 1336104785 |
---|---|
Provider Name | Dr. Mohammad O Tomeh |
First Address | East Point, GA 30344-3441 |
Second Address | East Point, GA 30344-3441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000392642A | (05) | GA |
E75469 | (02) |