Healthcare Provider Details

I. General information

NPI: 1619784436
Provider Name (Legal Business Name): MR. AMR MAHMOUD ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/21/2026
Certification Date:
Deactivation Date: 08/05/2025
Reactivation Date: 09/21/2026

III. Provider practice location address

80 JESSE HILL
ALANTA GA
30303
US

IV. Provider business mailing address

1005 1ST STREET SOUTHWEST ROCHESTER, 1005
ROCHESTER MN
55902
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 716-482-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: