Provider Demographics
NPI:1407289051
Name:ABO-ELHAMD, MOHAMED (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ABO-ELHAMD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HAMPSTEAD PL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6203
Mailing Address - Country:US
Mailing Address - Phone:706-364-5533
Mailing Address - Fax:552-328-6048
Practice Address - Street 1:1115 HAMPSTEAD PL
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-6203
Practice Address - Country:US
Practice Address - Phone:706-364-5533
Practice Address - Fax:552-328-6048
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist