Provider Demographics
NPI:1336185214
Name:YOUSEF, AHMED (PT, PHD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:YOUSEF
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7817
Mailing Address - Country:US
Mailing Address - Phone:478-751-2580
Mailing Address - Fax:478-953-6727
Practice Address - Street 1:1445 GEORGIA AVE
Practice Address - Street 2:SUITE I
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7610
Practice Address - Country:US
Practice Address - Phone:478-742-0904
Practice Address - Fax:478-743-2651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002335208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBDNMedicare ID - Type Unspecified