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General NPI Number Information
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NPI Number | 1194135939
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Entity Type | Individual
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Provider Name | MOHAMED MAHFOUD MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 678-312-2419
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 HIND ST
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City | SUWANEE
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State | GA
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Zip | 30024-5604
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Country | US
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Telephone | 404-472-6046
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Fax |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 95074
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 01081564A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 272388
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License Number State | MA
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