Provider Demographics
NPI:1891042628
Name:MAHMOUD, RITA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BOLLEN LN
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4178
Mailing Address - Country:US
Mailing Address - Phone:478-251-4436
Mailing Address - Fax:
Practice Address - Street 1:150 BOLLEN LN
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-4178
Practice Address - Country:US
Practice Address - Phone:478-251-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109444163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health