Provider Demographics
NPI:1356525448
Name:MOMIN, MOHAMED TAKKI A (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED TAKKI
Middle Name:A
Last Name:MOMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TAKKI
Other - Middle Name:ALTAF
Other - Last Name:MOMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2675 N DECATUR RD STE 512
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6134
Mailing Address - Country:US
Mailing Address - Phone:470-223-4707
Mailing Address - Fax:404-501-7062
Practice Address - Street 1:2675 N DECATUR RD STE 512
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6134
Practice Address - Country:US
Practice Address - Phone:470-223-4707
Practice Address - Fax:404-501-7062
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA578952086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery