Healthcare Provider Details

I. General information

NPI: 1104029479
Provider Name (Legal Business Name): SYED MINHAJ MAHMOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KING ABDUL AZIZ MEDICAL CITY, ICU DEPARTMENT 9515,
JEDDAH WESTERN REGION
21423
SA

IV. Provider business mailing address

201 HOSPITAL RD
CANTON GA
30114-2408
US

V. Phone/Fax

Practice location:
  • Phone: 011966122266666
  • Fax: 01196612226666621984
Mailing address:
  • Phone: 770-720-5100
  • Fax: 404-851-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number28220
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number59999
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMT187747
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number28220
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number59999
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: