Healthcare Provider Details

I. General information

NPI: 1861458762
Provider Name (Legal Business Name): MOHAMMAD A. AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MCAULEY DR
VICKSBURG MS
39183-2825
US

IV. Provider business mailing address

1502 S COLORADO ST
GREENVILLE MS
38703-7219
US

V. Phone/Fax

Practice location:
  • Phone: 601-638-7271
  • Fax: 601-631-2698
Mailing address:
  • Phone: 662-379-8141
  • Fax: 662-379-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number16065
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: