MEDICARE: MS. NADIA MOHAMMED PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2006028767	MO
2	363A00000X	Physician Assistant	2063	MA
3	363A00000X	Physician Assistant	006154	GA

General Provider Information

NPI Number	:	1124084322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NADIA MOHAMMED PA

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7070
Fax Number	:	617-629-6067

Provider Business Practice Location Address
First Line	:	750 TOWNPARK LN NW
Second Line	:	KAISER PERMANENTE TOWN PARK COMPREHENSIVE MEDICAL CENTE
City	:	KENNESAW
State	:	GA
Zip	:	30144-5579
Country	:	US
Telephone Number	:	770-514-5401
Fax Number	:	617-629-6067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/13/2022

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