MEDICARE: ALY ABBAS AHMED M.D.

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	2084P0800X	Psychiatry Physician	039026	GA

General Provider Information

NPI Number	:	1316064223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALY ABBAS AHMED M.D.

Provider Business Mailing Address
First Line	:	115 THE FARM RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6626
Country	:	US
Telephone Number	:	770-540-5897
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 COUNTRY CLUB DR
Second Line	:	SUITE 300B
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-9080
Country	:	US
Telephone Number	:	678-284-1008
Fax Number	:	678-284-1009

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/06/2015

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