Provider Demographics
NPI:1275589996
Name:AL-SAYED AHMAD, RIAD (MD)
Entity Type:Individual
Prefix:
First Name:RIAD
Middle Name:
Last Name:AL-SAYED AHMAD
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 1:1908 KEYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4812
Mailing Address - Country:US
Mailing Address - Phone:706-279-1994
Mailing Address - Fax:706-279-9229
Practice Address - Street 1:1610 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3012
Practice Address - Country:US
Practice Address - Phone:707-279-1994
Practice Address - Fax:706-279-9229
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54203174400000X
GA0542032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA803486775HMedicaid
GA803486775FMedicaid
GA803486775GMedicaid
GA803486775AMedicaid