Provider Demographics
NPI:1285796573
Name:JAHANIA, MOHAMMED SALIK A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED SALIK
Middle Name:A
Last Name:JAHANIA
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 1:975 E 3RD ST
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5661
Mailing Address - Fax:423-778-5664
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C-520
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5661
Practice Address - Fax:423-778-3146
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33241208G00000X
MI4301090533208G00000X
TN55464208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026653Medicaid
MI5195254Medicaid
KY64332414Medicaid
KY64332414Medicaid
MI0P30630486Medicare PIN
TNQ026653Medicaid