Healthcare Provider Details

I. General information

NPI: 1609030394
Provider Name (Legal Business Name): REDAH Z MAHMOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONEBRIDGE PKWY STE 110
WOODSTOCK GA
30189-3768
US

IV. Provider business mailing address

55 WHITCHER ST NE STE 350
MARIETTA GA
30060-1129
US

V. Phone/Fax

Practice location:
  • Phone: 678-324-4444
  • Fax: 678-324-4405
Mailing address:
  • Phone: 470-956-9639
  • Fax: 678-819-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301093085
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301093085
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number81668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: