MEDICARE: DR. MOUSA ELHAMMALI MOUSA 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
1	207RC0000X	Cardiovascular Disease Physician	03574	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407811193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOUSA ELHAMMALI MOUSA MD

Provider Business Mailing Address
First Line	:	1136 CLEVELAND AVE
Second Line	:	SUITE 410
City	:	EAST POINT
State	:	GA
Zip	:	30344-3618
Country	:	US
Telephone Number	:	404-762-6140
Fax Number	:	404-762-7922

Provider Business Practice Location Address
First Line	:	1136 CLEVELAND AVE
Second Line	:	SUITE 410
City	:	EAST POINT
State	:	GA
Zip	:	30344-3618
Country	:	US
Telephone Number	:	404-762-6140
Fax Number	:	404-762-7922

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	05/16/2013

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