Healthcare Provider Details

I. General information

NPI: 1427021310
Provider Name (Legal Business Name): OSMAN AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MONTREAL ROAD
TUCKER GA
30084
US

IV. Provider business mailing address

1468 MONTREAL ROAD
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 770-638-1400
  • Fax: 770-638-1411
Mailing address:
  • Phone: 770-638-1400
  • Fax: 770-638-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number62801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: