Provider Demographics
NPI:1093552713
Name:AHMED, SAMAH SALIH ABDALLA
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:SALIH ABDALLA
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-0368
Mailing Address - Country:US
Mailing Address - Phone:312-515-9537
Mailing Address - Fax:
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4996
Practice Address - Country:US
Practice Address - Phone:662-377-6652
Practice Address - Fax:662-377-1073
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125083175207RG0300X
MST-5958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine