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General NPI Number Information
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NPI Number | 1598158339
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Entity Type | Organization
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Legal Business Name | MOHAMMAD B. GHOURI
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 2032 WYNNTON RD SUITE D
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City | COLUMBUS
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State | GA
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Zip | 31906-2448
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Country | US
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Telephone | 706-407-5831
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Fax | 706-407-5832
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Provider Business Mailing Address
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Address Line | PO BOX 6237
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City | COLUMBUS
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State | GA
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Zip | 31917-6237
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Country | US
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Telephone | 706-407-5831
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Fax | 706-407-5832
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MOHAMMAD B BILAL
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Credential | M.D.
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Telephone | 706-718-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 58739
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License Number State | GA
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