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General NPI Number Information
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NPI Number | 1447529086
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Entity Type | Organization
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Legal Business Name | AHMED MOHAMED MD LLC
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 412 W 19TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4602
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Country | US
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Telephone | 850-522-4155
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Fax | 850-522-4156
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Provider Business Mailing Address
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Address Line | 1240 DUNDEE LN
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City | LYNN HAVEN
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State | FL
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Zip | 32444-8301
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Country | US
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Telephone | 850-522-5144
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Fax | 850-522-5146
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | AHMED MOHAMED
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Credential | M.D.
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Telephone | 850-522-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | ME81605
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License Number State | FL
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