Provider Demographics
NPI:1912342841
Name:AL FAYYADH, MOHAMMED JAAFAR ATTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:JAAFAR ATTA
Last Name:AL FAYYADH
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 1:470 NORTHSIDE CHEROKEE BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8029
Mailing Address - Country:US
Mailing Address - Phone:770-277-4277
Mailing Address - Fax:404-252-5745
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 365
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-277-4277
Practice Address - Fax:404-252-5745
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA84831208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program