Healthcare Provider Details

I. General information

NPI: 1326081647
Provider Name (Legal Business Name): MUHAMAD KAMIL OBIDEEN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD ATLANTA VA MEDICAL CENTER
DECATUR GA
30033-4004
US

IV. Provider business mailing address

622 HIGHLAND LAKE CIR
DECATUR GA
30033-3446
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-728-7746
Mailing address:
  • Phone: 404-329-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number053009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: