Provider Demographics
NPI:1568080646
Name:MUHAMMAD, MARYAM A (NP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:A
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 REEVES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7229
Mailing Address - Country:US
Mailing Address - Phone:804-366-2748
Mailing Address - Fax:
Practice Address - Street 1:2388 REEVES CREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-7229
Practice Address - Country:US
Practice Address - Phone:804-366-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN267850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily