Provider Demographics
NPI:1558587659
Name:MOMIN, KAMELA (MD)
Entity Type:Individual
Prefix:
First Name:KAMELA
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 FIELD HOUSE CIR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5283
Mailing Address - Country:US
Mailing Address - Phone:678-770-8539
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIAN TRAIL RD STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4502
Practice Address - Country:US
Practice Address - Phone:678-580-5249
Practice Address - Fax:678-580-5719
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63880208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics