Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | E-11695 | AR |
Y | 207Q00000X | Family Doctor | E-11695 | AR |
N | 207RG0300X | Geriatric Medicine | 4301104828 | MI |
N | 208D00000X | General Practice Physician | 074885 | GA |
NPI | 1053725499 |
---|---|
Provider Name | Dr. Mohanned Hassan Mohammed Ahmed |
First Address | Decatur, GA 30035-3411 |
Second Address | Pine Bluff, AR 71603-6301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 23/07/2019 |