Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 043997 | GA |
N | 2084N0400X | Neurologist | GEORGIA | GA |
NPI | 1043394109 |
---|---|
Provider Name | Mohammad Ali Kukaswadia |
First Address | Mableton, GA 30126-5685 |
Second Address | Douglasville, GA 30135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 15/09/2020 |