Provider Demographics
NPI:1992745137
Name:ASLAM, MOHAMMAD A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:ASLAM
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 1:105 TOMMY STALNAKER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8956
Mailing Address - Country:US
Mailing Address - Phone:478-333-3612
Mailing Address - Fax:478-333-3631
Practice Address - Street 1:105 TOMMY STALNAKER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8956
Practice Address - Country:US
Practice Address - Phone:478-333-3612
Practice Address - Fax:478-333-3631
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050597207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000968613QMedicaid
GA000968613OMedicaid
GA000968613ZMedicaid
GA000968613PMedicaid
GA000968613QMedicaid
GA11SCHNRMedicare PIN
GA000968613OMedicaid
GA000968613ZMedicaid