Healthcare Provider Details

I. General information

NPI: 1992745137
Provider Name (Legal Business Name): MOHAMMAD A ASLAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TOMMY STALNAKER DR SUITE 1
WARNER ROBINS GA
31088-8956
US

IV. Provider business mailing address

105 TOMMY STALNAKER DR SUITE 1
WARNER ROBINS GA
31088-8956
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-3612
  • Fax: 478-333-3631
Mailing address:
  • Phone: 478-333-3612
  • Fax: 478-333-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050597
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number050597
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: