Provider Demographics
NPI:1700826906
Name:HOSSAIN, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:HOSSAIN
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 1:1324 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3784
Mailing Address - Country:US
Mailing Address - Phone:615-794-1542
Mailing Address - Fax:615-595-1214
Practice Address - Street 1:1324 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3784
Practice Address - Country:US
Practice Address - Phone:615-794-1542
Practice Address - Fax:615-595-1214
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3829573Medicaid
TN3829573Medicaid
TN3829573Medicare ID - Type Unspecified