Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 11627 | GA |
NPI | 1164067112 |
---|---|
Provider Name | Eltayeb Mohamed Ahmed |
First Address | Atlanta, GA 30328-5883 |
Second Address | Atlanta, GA 30342-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |