| Dekalb Internal Medicine Associates, Pc | |
|
1980 Montreal Rd Tucker GA 30084-5217 | |
| (770) 270-4060 | |
| (770) 270-4061 |
| Full Name | Dekalb Internal Medicine Associates, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1980 Montreal Rd, Tucker, Georgia |
| Authorized Official Name and Position | Ali M Mohamed (CEO) |
| Authorized Official Contact | 7702704060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dekalb Internal Medicine Associates, Pc 1980 Montreal Rd Tucker GA 30084-5217 Ph: (770) 270-4060 | Dekalb Internal Medicine Associates, Pc 1980 Montreal Rd Tucker GA 30084-5217 Ph: (770) 270-4060 |
| NPI Number | 1255615852 |
|---|---|
| Provider Enumeration Date | 10/01/2011 |
| Last Update Date | 10/01/2011 |
| Medicare PECOS PAC ID | 4880854009 |
|---|---|
| Medicare Enrollment ID | O20120327000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255615852 | NPI | - | NPPES |
| 00815075B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 046623 (Georgia) | Primary |
| Provider Name | Ali Moallin Mohamed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154448967 PECOS PAC ID: 7416117643 Enrollment ID: I20120327000198 |
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