MEDICARE: MOHAMMAD B. GHOURI

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	207R00000X	Internal Medicine Physician	58739	GA

General Provider Information

NPI Number	:	1598158339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMMAD B. GHOURI

Provider Business Mailing Address
First Line	:	PO BOX 6237
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31917-6237
Country	:	US
Telephone Number	:	706-407-5831
Fax Number	:	706-407-5832

Provider Business Practice Location Address
First Line	:	2032 WYNNTON RD
Second Line	:	SUITE D
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2448
Country	:	US
Telephone Number	:	706-407-5831
Fax Number	:	706-407-5832

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MOHAMMAD B BILAL
Credential	:	M.D.
Telephone Number	:	706-718-5985

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	04/21/2015

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