Healthcare Provider Details

I. General information

NPI: 1659330587
Provider Name (Legal Business Name): MOHAMMAD AL-MULKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLEVELAND AVE STE 519
EAST POINT GA
30344-3618
US

IV. Provider business mailing address

PO BOX 91485
EAST POINT GA
30364-1485
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-3525
  • Fax: 404-766-3696
Mailing address:
  • Phone: 404-761-3525
  • Fax: 404-766-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number020396
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number020396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: