Provider Demographics
NPI:1215939269
Name:BAH, MOHAMMED M (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:M
Last Name:BAH
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 1466
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1466
Mailing Address - Country:US
Mailing Address - Phone:901-355-7197
Mailing Address - Fax:
Practice Address - Street 1:1204 N HOUSTON LEVEE RD STE 114
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6687
Practice Address - Country:US
Practice Address - Phone:901-421-5000
Practice Address - Fax:901-572-1241
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37715207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH90971Medicare UPIN