Basic Information
| Provider Information | |||||||||
| NPI: | 1477517399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAMMED | ||||||||
| FirstName: | AMINU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 993D JOHNSON FERRY RD NE | ||||||||
| Address2: | STE 440 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042570799 | ||||||||
| FaxNumber: | 4045032280 | ||||||||
| Practice Location | |||||||||
| Address1: | 993D JOHNSON FERRY RD NE | ||||||||
| Address2: | STE 440 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042570799 | ||||||||
| FaxNumber: | 4045032280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/01/2018 | ||||||||
| NPIReactivationDate: | 03/09/2018 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 056591 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0206X | 056591 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 369858735 | 05 | GA | MEDICAID |