Provider Demographics
NPI:1265497812
Name:WARIS, MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:WARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S COBB DR SE STE 107
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7821
Mailing Address - Country:US
Mailing Address - Phone:770-432-3344
Mailing Address - Fax:770-432-3355
Practice Address - Street 1:3001 S COBB DR SE STE 107
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7821
Practice Address - Country:US
Practice Address - Phone:770-432-3344
Practice Address - Fax:770-432-3355
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90190208000000X
GA62300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270569900Medicaid
FL270569900Medicaid
FL48526ZMedicare ID - Type UnspecifiedMEDICARE NUMBER