Provider Demographics
NPI:1811655533
Name:ABDULLAH, MAHDIY (LMT)
Entity type:Individual
Prefix:
First Name:MAHDIY
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3964
Mailing Address - Country:US
Mailing Address - Phone:470-591-9436
Mailing Address - Fax:
Practice Address - Street 1:4633 BUFORD DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3713
Practice Address - Country:US
Practice Address - Phone:470-591-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012222225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist