1003486457 NPI number — ALAA SALAH HAMADTALLA MOHAMED MBBS

Table of content: ALAA SALAH HAMADTALLA MOHAMED MBBS (NPI 1003486457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003486457 NPI number — ALAA SALAH HAMADTALLA MOHAMED MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAMED
Provider First Name:
ALAA
Provider Middle Name:
SALAH HAMADTALLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
F

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:
1003486457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AL AZHAR STREET, MEDICAL CITY, ALSADD
Provider Second Line Business Mailing Address:
BUILDING 306 , APT 108
Provider Business Mailing Address City Name:
DOHA
Provider Business Mailing Address State Name:
DOHA
Provider Business Mailing Address Postal Code:
00000
Provider Business Mailing Address Country Code:
QA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1399 WALTON WAY APT 118
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-2680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-655-4952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2021

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: 2084N0400X , with the licence number:  13414 , 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)





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