Provider Demographics
NPI:1891726121
Name:KASSEM, MOHAMAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:M
Last Name:KASSEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3580 CAMERON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-996-6446
Mailing Address - Fax:770-996-6279
Practice Address - Street 1:3580 CAMERON PARKWAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-996-6446
Practice Address - Fax:770-996-6279
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040934207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00681678BMedicaid
GA39BDBWWMedicare ID - Type Unspecified
GA00681678BMedicaid