Provider Demographics
NPI:1467416602
Name:JINGO, AHMAD K (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:K
Last Name:JINGO
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 1:3424 FLAT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6525
Mailing Address - Country:US
Mailing Address - Phone:404-968-8269
Mailing Address - Fax:404-968-8274
Practice Address - Street 1:3424 FLAT SHOALS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6525
Practice Address - Country:US
Practice Address - Phone:404-968-8269
Practice Address - Fax:404-968-8274
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00804339DMedicaid
GA11BDQPMMedicare ID - Type Unspecified
GA00804339DMedicaid