Provider Demographics
NPI:1194411249
Name:MOHAMED, MOHAMED AME (CNA)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AME
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 HARBINS RD NW APT 534
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5842
Mailing Address - Country:US
Mailing Address - Phone:678-790-6122
Mailing Address - Fax:
Practice Address - Street 1:950 HARBINS RD NW APT 534
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5842
Practice Address - Country:US
Practice Address - Phone:678-790-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00300855143140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric