Provider Demographics
NPI:1184856494
Name:AHMED ELSHARKAWI MD LLC
Entity Type:Organization
Organization Name:AHMED ELSHARKAWI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHARKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-267-4900
Mailing Address - Street 1:390 EH CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2198
Mailing Address - Country:US
Mailing Address - Phone:912-267-4900
Mailing Address - Fax:912-267-4960
Practice Address - Street 1:390 EH CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2198
Practice Address - Country:US
Practice Address - Phone:912-267-4900
Practice Address - Fax:912-267-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55128207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA663552717AMedicaid
GA663552717AMedicaid