Provider Demographics
NPI:1124084322
Name:MOHAMMED, NADIA (PA)
Entity type:Individual
Prefix:MS
First Name:NADIA
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:617-629-6067
Practice Address - Street 1:750 TOWNPARK LN NW
Practice Address - Street 2:KAISER PERMANENTE TOWN PARK COMPREHENSIVE MEDICAL CENTE
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5579
Practice Address - Country:US
Practice Address - Phone:770-514-5401
Practice Address - Fax:617-629-6067
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006028767363A00000X
MA2063363A00000X
GA006154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q74494Medicare UPIN
P00405317Medicare PIN
000097368Medicare PIN