Provider Demographics
NPI:1760467013
Name:MOMIN, SOHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SOHEL
Middle Name:
Last Name:MOMIN
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 1:1400 NORTHSIDE FORSYTH DR STE 240
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6017
Mailing Address - Country:US
Mailing Address - Phone:770-844-0877
Mailing Address - Fax:770-844-0891
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 240
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6017
Practice Address - Country:US
Practice Address - Phone:770-844-0877
Practice Address - Fax:770-844-0891
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA589566942FMedicaid
I19531Medicare UPIN
GA589566942FMedicaid
GA11SCFSWMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER