Provider Demographics
NPI:1104029479
Name:MAHMOOD, SYED MINHAJ (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MINHAJ
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2408
Mailing Address - Country:US
Mailing Address - Phone:770-720-5100
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:KING ABDUL AZIZ MEDICAL CITY, ICU DEPARTMENT
Practice Address - Street 2:9515,
Practice Address - City:JEDDAH
Practice Address - State:WESTERN REGION
Practice Address - Zip Code:21423
Practice Address - Country:SA
Practice Address - Phone:01196612-226-6666
Practice Address - Fax:0119661222666-662-1984
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28220207RC0200X, 207RP1001X
GA59999207RC0200X, 207RP1001X
PAMT187747207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA585869138BMedicaid
AL009913059Medicaid
GA585869138BMedicaid
AL510I80001Medicare PIN
AL009913059Medicaid