Provider Demographics
NPI:1922557909
Name:ABDELGHANI, MAHMOD (DNP)
Entity Type:Individual
Prefix:
First Name:MAHMOD
Middle Name:
Last Name:ABDELGHANI
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 POPLAR AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-0101
Mailing Address - Country:US
Mailing Address - Phone:901-276-2662
Mailing Address - Fax:901-274-2033
Practice Address - Street 1:5050 POPLAR AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0101
Practice Address - Country:US
Practice Address - Phone:901-276-2662
Practice Address - Fax:901-274-2033
Is Sole Proprietor?:No
Enumeration Date:2016-10-01
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000021648363LF0000X
TN21648363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily