Healthcare Provider Details

I. General information

NPI: 1205824810
Provider Name (Legal Business Name): AMIR R AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR STE 120
COLUMBIA SC
29203-6850
US

IV. Provider business mailing address

1111 MEDICAL PLAZA DR STE 250
THE WOODLANDS TX
77380-3477
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8866
  • Fax: 803-933-3049
Mailing address:
  • Phone: 865-483-4366
  • Fax: 865-483-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2022014629
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2013-00585
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number39148
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number52921
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberL8585
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036171841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: