Provider Demographics
NPI:1699708008
Name:MOHAMED, EMAD HASHIM (MD)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:HASHIM
Last Name:MOHAMED
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CENTRE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2862
Mailing Address - Country:US
Mailing Address - Phone:731-512-0104
Mailing Address - Fax:731-668-7388
Practice Address - Street 1:17 CENTRE PLAZA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2862
Practice Address - Country:US
Practice Address - Phone:731-512-0104
Practice Address - Fax:731-668-7388
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16576207RC0000X
TN53599207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04979841Medicaid
P00208382Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MS04979841Medicaid
MS04979841Medicaid
I02529Medicare UPIN
MS060000787Medicare ID - Type Unspecified