Provider Demographics
NPI:1629489547
Name:MESSALLAM, AHMED ALY (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:ALY
Last Name:MESSALLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 CANTON RD NE STE 328
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7289
Mailing Address - Country:US
Mailing Address - Phone:470-267-1760
Mailing Address - Fax:470-986-7002
Practice Address - Street 1:780 CANTON RD NE STE 328
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7289
Practice Address - Country:US
Practice Address - Phone:470-267-1760
Practice Address - Fax:470-986-7002
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA390200000X
GA74933207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program