Provider Demographics
NPI:1295943223
Name:MOHAMMAD A SABUR NASIRI
Entity type:Organization
Organization Name:MOHAMMAD A SABUR NASIRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SABUR
Authorized Official - Last Name:NASIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-485-0900
Mailing Address - Street 1:508 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4434
Mailing Address - Country:US
Mailing Address - Phone:910-485-0900
Mailing Address - Fax:910-485-0080
Practice Address - Street 1:508 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4434
Practice Address - Country:US
Practice Address - Phone:910-485-0900
Practice Address - Fax:910-485-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35740261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6961881Medicaid