Provider Demographics
NPI:1609030394
Name:MAHMOOD, REDAH Z (MD)
Entity Type:Individual
Prefix:DR
First Name:REDAH
Middle Name:Z
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE STE 350
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1129
Mailing Address - Country:US
Mailing Address - Phone:470-956-9639
Mailing Address - Fax:678-819-0357
Practice Address - Street 1:120 STONEBRIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3768
Practice Address - Country:US
Practice Address - Phone:678-324-4444
Practice Address - Fax:678-324-4405
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093085207P00000X, 207R00000X
GA81668207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1609030394Medicaid
12330056OtherCAQH