Provider Demographics
NPI:1770222408
Name:MAWIA, SAUDAT MOHAMMED
Entity Type:Individual
Prefix:DR
First Name:SAUDAT
Middle Name:MOHAMMED
Last Name:MAWIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5014
Mailing Address - Country:US
Mailing Address - Phone:706-569-9439
Mailing Address - Fax:
Practice Address - Street 1:4808 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5014
Practice Address - Country:US
Practice Address - Phone:706-569-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist