1104029479 NPI number — SYED MINHAJ MAHMOOD MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104029479 NPI number — SYED MINHAJ MAHMOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHMOOD
Provider First Name:
SYED
Provider Middle Name:
MINHAJ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1104029479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-720-5100
Provider Business Mailing Address Fax Number:
404-851-6325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KING ABDUL AZIZ MEDICAL CITY, ICU DEPARTMENT
Provider Second Line Business Practice Location Address:
9515,
Provider Business Practice Location Address City Name:
JEDDAH
Provider Business Practice Location Address State Name:
WESTERN REGION
Provider Business Practice Location Address Postal Code:
21423
Provider Business Practice Location Address Country Code:
SA
Provider Business Practice Location Address Telephone Number:
011966122266666
Provider Business Practice Location Address Fax Number:
01196612226666621984
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  28220 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 59999 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MT187747 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 28220 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 59999 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 585869138B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009913059 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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