Basic Information
| Provider Information | |||||||||
| NPI: | 1245890359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELKHALIFA | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | YOUSIF | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 CLIFTON RD | ||||||||
| Address2: | 1ST FLOOR PATHOLOGY | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047856499 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1405 CLIFTON RD | ||||||||
| Address2: | 1ST FLOOR PATHOLOGY | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047856499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0006X | 83181 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology |
No ID Information.