Provider Demographics
NPI:1710934153
Name:AWDEH, MAHIR R (MD)
Entity Type:Individual
Prefix:
First Name:MAHIR
Middle Name:R
Last Name:AWDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVENUE
Mailing Address - Street 2:SUITE 500 B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5215
Mailing Address - Country:US
Mailing Address - Phone:901-683-6925
Mailing Address - Fax:901-684-1435
Practice Address - Street 1:6005 PARK AVENUE
Practice Address - Street 2:SUITE 500 B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5215
Practice Address - Country:US
Practice Address - Phone:901-683-6925
Practice Address - Fax:901-684-1435
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN10521207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR107031001Medicaid
TN1514379Medicaid
MS8785559Medicaid