Provider Demographics
NPI:1861458762
Name:AHMED, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1502 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7219
Mailing Address - Country:US
Mailing Address - Phone:662-379-8141
Mailing Address - Fax:662-379-8020
Practice Address - Street 1:104 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2825
Practice Address - Country:US
Practice Address - Phone:601-638-7271
Practice Address - Fax:601-631-2698
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS160652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119831Medicaid
MS130025440Medicare PIN
G92376Medicare UPIN
MS00119831Medicaid
MS130000225Medicare PIN