Basic Information
| Provider Information | |||||||||
| NPI: | 1396157657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDELSALAM | ||||||||
| FirstName: | ALMATMED | ||||||||
| MiddleName: | H MOHAMED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26040 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312216040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784751299 | ||||||||
| FaxNumber: | 4784057928 | ||||||||
| Practice Location | |||||||||
| Address1: | 657 HEMLOCK ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312018311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787417241 | ||||||||
| FaxNumber: | 4787458932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2014 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME129683 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 77419 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 108917500 | 05 | FL | MEDICAID | NC195 | 01 | FL | MEDICARE HF | OTHER |