Provider Demographics
NPI:1558538900
Name:MOHAMMED OBEIDIN, MD.
Entity Type:Organization
Organization Name:MOHAMMED OBEIDIN, MD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:OBEIDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-548-0991
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 600F
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-548-0991
Mailing Address - Fax:706-548-0184
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:SUITE 186N
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-548-0991
Practice Address - Fax:706-548-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000535972AMedicaid
GA000535972AMedicaid