Healthcare Provider Details

I. General information

NPI: 1134240682
Provider Name (Legal Business Name): AHMED ELHAIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1629 ELKWOOD CT
ANNAPOLIS MD
21409-5477
US

V. Phone/Fax

Practice location:
  • Phone: 706-825-8187
  • Fax:
Mailing address:
  • Phone: 706-825-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30510
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number001291
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD0068610
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number161837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: