MEDICARE: SYED AHMED

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	MD.41332	AL

General Provider Information

NPI Number	:	1477087427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED AHMED

Provider Business Mailing Address
First Line	:	1722 PINE ST STE 203
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1158
Country	:	US
Telephone Number	:	334-293-8736
Fax Number	:	334-293-8738

Provider Business Practice Location Address
First Line	:	4035 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2920
Country	:	US
Telephone Number	:	334-603-8708
Fax Number	:	334-603-8709

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

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	09/28/2020

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