Provider Demographics
NPI:1578519286
Name:AL SHROOF, MOHAMMAD N (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:N
Last Name:AL SHROOF
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 1:2054 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3634
Mailing Address - Country:US
Mailing Address - Phone:478-918-0770
Mailing Address - Fax:478-918-0771
Practice Address - Street 1:2054 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3634
Practice Address - Country:US
Practice Address - Phone:478-918-0770
Practice Address - Fax:478-918-0771
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000807155IMedicaid
GA000807155RMedicaid
GA614236400OtherDEPT OF LABOR
1578519286OtherNPI
GA468916OtherWELLCARE
GA000807155ABMedicaid
511I110627OtherMEDICARE PTAN
GA000807155ACMedicaid
GA867194728AOtherGBHC
GA110237442OtherMEDICARE RAILROAD#
511I110627OtherMEDICARE PTAN
GA867194728AOtherGBHC