Provider Demographics
NPI:1154448967
Name:MOHAMED, ALI M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:M
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1459 MONTREAL RD
Mailing Address - Street 2:STE 312
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6900
Mailing Address - Country:US
Mailing Address - Phone:770-270-4060
Mailing Address - Fax:770-270-4061
Practice Address - Street 1:1459 MONTREAL RD
Practice Address - Street 2:STE 312
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6900
Practice Address - Country:US
Practice Address - Phone:770-270-4060
Practice Address - Fax:770-270-4061
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA046623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00815075BMedicaid
GA0007493308OtherAETNA
GA52667599OtherBLUE CROSS BLUE SHIELD
GA00815075BMedicaid
GA0007493308OtherAETNA