Healthcare Provider Details

I. General information

NPI: 1720802523
Provider Name (Legal Business Name): MOHAMMAD SALMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OCILLA RD
DOUGLAS GA
31533-2262
US

IV. Provider business mailing address

1101 OCILLA RD
DOUGLAS GA
31533-2262
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-1900
  • Fax:
Mailing address:
  • Phone: 912-384-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351054785
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number112326
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP130909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: