Healthcare Provider Details

I. General information

NPI: 1295569473
Provider Name (Legal Business Name): MOGAHED ISMAIL HASSAN HUSSEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

308 SUMAC TRL
EVANS GA
30809-0789
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-3873
  • Fax:
Mailing address:
  • Phone: 706-721-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number57.257337
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number110010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: