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General NPI Number Information
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NPI Number | 1043394109
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI KUKASWADIA MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 4904 TIMBER RIDGE DRIVE SUITE 305
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 678-501-5420
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Fax | 678-501-5427
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Provider Business Mailing Address
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Address Line | 822 RIVERTON PARK PL SE
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City | MABLETON
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State | GA
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Zip | 30126-5685
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Country | US
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Telephone | 678-501-5420
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Fax | 678-501-5427
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | GEORGIA
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 043997
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License Number State | GA
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