MEDICARE: DR. OBAIDULLAH AHMED MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	044879	GA
2	207Q00000X	Family Medicine Physician	ME85133	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01693563	OTHER	GA	RR MEDICARE

General Provider Information

NPI Number	:	1235190646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBAIDULLAH AHMED MD

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	851042 US HIGHWAY 17
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-2845
Country	:	US
Telephone Number	:	904-225-3824
Fax Number	:	904-390-7440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	05/07/2024

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