Healthcare Provider Details

I. General information

NPI: 1144647041
Provider Name (Legal Business Name): AMAL IDRIS AHMED ELHAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 SPRUCE ST
BELMONT NC
28012-3385
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1700
  • Fax: 704-865-7948
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2019-00271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: