Provider Demographics
NPI:1003552076
Name:MAHMOOD, SITWAT
Entity type:Individual
Prefix:
First Name:SITWAT
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 HARBOR CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9382
Mailing Address - Country:US
Mailing Address - Phone:404-859-5715
Mailing Address - Fax:
Practice Address - Street 1:1200 BALD RIDGE MARINA RD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8526
Practice Address - Country:US
Practice Address - Phone:770-781-8650
Practice Address - Fax:470-297-3863
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice