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NPI Code Detail

MEDICARE: DR. MOHAMED MIDANI MD

MEDICARE: DR. MOHAMED MIDANI MD
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
1208000000XPediatrics Physician019080GA

General Provider Information

NPI Number : 1295724383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMED MIDANI MD
Provider Business Mailing Address
First Line : 2230 TOWNE LAKE PKWY
Second Line : BUILDING 300, SUITE 100
City : WOODSTOCK
State : GA
Zip : 30189-5540
Country : US
Telephone Number : 770-517-1900
Fax Number : 770-926-3215
Provider Business Practice Location Address
First Line : 145 N MEDICAL PKWY
Second Line :
City : WOODSTOCK
State : GA
Zip : 30189-7031
Country : US
Telephone Number : 770-517-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 10/11/2019

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Directions to “ DR. MOHAMED MIDANI MD” Practice Location

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