Healthcare Provider Details

I. General information

NPI: 1215143573
Provider Name (Legal Business Name): KALEEM AHMED MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 HOSPITAL RD SUITE 2
COMMERCE GA
30529-1155
US

IV. Provider business mailing address

641 HOSPITAL RD SUITE 2
COMMERCE GA
30529-1155
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-4212
  • Fax:
Mailing address:
  • Phone: 706-335-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number037118
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00684571B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier499321
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerBCBS
# 3
Identifier00684571C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier00684571E
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 5
Identifier110147788
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier001421918
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerUNITED HEALTHCARE
# 7
Identifier52499321
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 8
Identifier00684571D
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 9
Identifier00684571A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 10
Identifier2542958
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerCHESAPEAKE LIFE INSURANCE

VIII. Authorized Official

Name: DR. KALEEM AHMED
Title or Position: OWNER
Credential: MD
Phone: 706-335-4212