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General NPI Number Information
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NPI Number | 1184606824
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Entity Type | Individual
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Provider Name | MAHMOOD SAYIED EISA MD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4274 N VALDOSTA RD
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City | VALDOSTA
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State | GA
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Zip | 31602-6814
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Country | US
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Telephone | 229-242-1234
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Fax | 229-247-8110
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Provider Business Mailing Address
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Address Line | 4274 N VALDOSTA RD
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City | VALDOSTA
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State | GA
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Zip | 31602-6814
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Country | US
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Telephone | 229-242-1234
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Fax | 229-247-8110
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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 | 057162
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License Number State | GA
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