Provider Demographics
NPI:1598158339
Name:MOHAMMAD B. GHOURI
Entity Type:Organization
Organization Name:MOHAMMAD B. GHOURI
Other - Org Name:GHOURI MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BILAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-718-5985
Mailing Address - Street 1:PO BOX 6237
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31917-6237
Mailing Address - Country:US
Mailing Address - Phone:706-407-5831
Mailing Address - Fax:706-407-5832
Practice Address - Street 1:2032 WYNNTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2448
Practice Address - Country:US
Practice Address - Phone:706-407-5831
Practice Address - Fax:706-407-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty