Provider Demographics
NPI:1235316894
Name:HADI, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:HADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6097
Mailing Address - Country:US
Mailing Address - Phone:770-957-1887
Mailing Address - Fax:770-957-6864
Practice Address - Street 1:50 KELLY RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6097
Practice Address - Country:US
Practice Address - Phone:770-957-1887
Practice Address - Fax:770-957-6864
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73757207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191866Medicare PIN
LA191851Medicare PIN
LA191865Medicare PIN
LA4N493DJ03Medicare PIN
LA191834Medicare PIN
LA4N493CD42Medicare PIN
LA1106267Medicaid
LA4N493CY49Medicare PIN
LA4N493Medicare PIN