Provider Demographics
NPI:1952336943
Name:SHAHIDSALLES, MOHAMAD SAEED S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD SAEED
Middle Name:S
Last Name:SHAHIDSALLES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TREE LANE RD SUITE 160
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-978-3578
Mailing Address - Fax:770-978-6630
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 350
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-978-3578
Practice Address - Fax:770-978-6630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA130022491OtherRAILROAD MEDICARE
GA1952336943OtherHUMANA
GA000049025Medicaid
GA00466408BMedicaid
GA582320860OtherHUMANA
GA13BDBBFMedicare PIN
GA130022491OtherRAILROAD MEDICARE