Provider Demographics
NPI:1326677907
Name:HAMAD AHMAD MD PC
Entity Type:Organization
Organization Name:HAMAD AHMAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-873-0930
Mailing Address - Street 1:4772 NAVY ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-873-0930
Mailing Address - Fax:901-873-0931
Practice Address - Street 1:6490 MEMPHIS ARLINGTON RD SUITE 106
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135
Practice Address - Country:US
Practice Address - Phone:901-762-1531
Practice Address - Fax:901-762-1532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMAD AHMAD MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ031157Medicaid