=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093552713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMAH SALIH ABDALLA AHMED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2024
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 S GLOSTER ST
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-377-6652
-----------------------------------------------------
Fax | 662-377-1073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1443 GUN CLUB RD
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-0368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-515-9537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 125083175
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | T-5958
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------