Provider Demographics
NPI:1194718841
Name:ABDULRAHMAN, AMJAD (MD)
Entity type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:
Last Name:ABDULRAHMAN
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:7430 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2903
Practice Address - Country:US
Practice Address - Phone:803-732-4001
Practice Address - Fax:803-799-1922
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00057303OtherRAILROAD MEDICARE
SC216714Medicaid
SCH146539615Medicare PIN
H146535038Medicare PIN
SCH14653Medicare UPIN