MEDICARE: FATIMAH N MUHAMMAD

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1326537051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMAH N MUHAMMAD

Provider Business Mailing Address
First Line	:	2067 LAKE PARK DR SE APT G
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7628
Country	:	US
Telephone Number	:	678-235-4156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2067 LAKE PARK DR SE APT G
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7628
Country	:	US
Telephone Number	:	678-235-4156
Fax Number	:

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/08/2018

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