Provider Demographics
NPI:1316064223
Name:AHMED, ALY ABBAS (MD)
Entity type:Individual
Prefix:
First Name:ALY
Middle Name:ABBAS
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:115 THE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6626
Mailing Address - Country:US
Mailing Address - Phone:770-540-5897
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 300B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9080
Practice Address - Country:US
Practice Address - Phone:678-284-1008
Practice Address - Fax:678-284-1009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0390262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry