Provider Demographics
NPI:1124119573
Name:MAHMOOD, SYED TARIQ (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:TARIQ
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JOHNSON FERRY RD STE 510
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1743
Mailing Address - Country:US
Mailing Address - Phone:404-419-1165
Mailing Address - Fax:404-419-1164
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-2300
Practice Address - Fax:404-851-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48689207R00000X
FLME105231207RH0003X
GA081524207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN035188000Medicaid
FL001256800Medicaid
MN035188000Medicaid
FLI63449Medicare UPIN
MN110010871Medicare ID - Type Unspecified
FLCL904YMedicare PIN