1215143573 NPI number — KALEEM AHMED MD PC

Table of content: (NPI 1215143573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215143573 NPI number — KALEEM AHMED MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALEEM AHMED MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215143573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 HOSPITAL RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
COMMERCE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30529-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-335-4212
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
641 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
COMMERCE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30529-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-335-4212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
KALEEM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-335-4212

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  037118 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00684571B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 499321 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00684571C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00684571E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110147788 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 001421918 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52499321 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00684571D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00684571A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2542958 . This is a "CHESAPEAKE LIFE INSURANCE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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