Provider Demographics
NPI:1215305305
Name:AHMED ELSHARKAWI, MD LLC
Entity type:Organization
Organization Name:AHMED ELSHARKAWI, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHARKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-262-2723
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-262-2723
Mailing Address - Fax:912-264-5609
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 601
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-262-2723
Practice Address - Fax:912-264-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherSOCIAL SECURTIY NUMBER