Healthcare Provider Details

I. General information

NPI: 1467614438
Provider Name (Legal Business Name): SADIA MAHMOOD ALI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SADIA MAHMOOD DPM

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 COBB PKWY NW STE 470
KENNESAW GA
30152-1042
US

IV. Provider business mailing address

3161 COBB PKWY NW STE 470
KENNESAW GA
30152-1042
US

V. Phone/Fax

Practice location:
  • Phone: 678-262-5108
  • Fax: 678-996-4072
Mailing address:
  • Phone: 678-262-5108
  • Fax: 678-996-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001220
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005506
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001220
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: