Healthcare Provider Details

I. General information

NPI: 1801788336
Provider Name (Legal Business Name): MOHAMMED HADI USMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax: 647-703-9424
Mailing address:
  • Phone: 706-721-7005
  • Fax: 647-703-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105387
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: