Healthcare Provider Details

I. General information

NPI: 1396733796
Provider Name (Legal Business Name): MOHAMMED Y ABUBAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 NORTH AVE NW
MARIETTA GA
30060-1127
US

IV. Provider business mailing address

670 NORTH AVE NW
MARIETTA GA
30060-1127
US

V. Phone/Fax

Practice location:
  • Phone: 770-590-8328
  • Fax: 770-590-9231
Mailing address:
  • Phone: 770-590-8328
  • Fax: 770-590-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number045683
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number045683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: