Provider Demographics
NPI:1245810191
Name:JAMA, MOHAMED AHMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMED
Last Name:JAMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 GLASTONBURY RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5041
Mailing Address - Country:US
Mailing Address - Phone:615-504-0661
Mailing Address - Fax:
Practice Address - Street 1:1058 GLASTONBURY RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-5041
Practice Address - Country:US
Practice Address - Phone:615-504-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN226195343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)