Provider Demographics
NPI:1366720336
Name:MAHMOUD, FETHIYA MOHAMMED
Entity type:Individual
Prefix:
First Name:FETHIYA
Middle Name:MOHAMMED
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FETHIYA
Other - Middle Name:MOHAMMED
Other - Last Name:MAHMOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE NUMBER D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE NUMBER D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2923
Practice Address - Country:US
Practice Address - Phone:251-344-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine