Provider Demographics
NPI:1730965039
Name:MOHAMOUD, FARAH
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MOHAMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 COPELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2501
Mailing Address - Country:US
Mailing Address - Phone:404-247-0435
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR STE 230
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-9929
Practice Address - Country:US
Practice Address - Phone:470-400-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor