Provider Demographics
NPI:1790130540
Name:ALI, MOHAMMED KUMAIL (MD, MSC, MBA)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:KUMAIL
Last Name:ALI
Suffix:
Gender:M
Credentials:MD, MSC, MBA
Other - Prefix:
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Mailing Address - Street 1:158 W PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2527
Mailing Address - Country:US
Mailing Address - Phone:404-251-2200
Mailing Address - Fax:404-377-0814
Practice Address - Street 1:158 W PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2527
Practice Address - Country:US
Practice Address - Phone:404-251-2200
Practice Address - Fax:404-377-0814
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA81987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program