Healthcare Provider Details

I. General information

NPI: 1699179556
Provider Name (Legal Business Name): ABDRAHIM ALOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N CANDLER ST
DECATUR GA
30030-2626
US

IV. Provider business mailing address

3601 4TH ST STOP 6211
LUBBOCK TX
79430-6211
US

V. Phone/Fax

Practice location:
  • Phone: 415-532-5235
  • Fax:
Mailing address:
  • Phone: 806-743-2978
  • Fax: 806-743-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number72159
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number72159
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number85593
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number85593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: