Provider Demographics
NPI:1861593519
Name:MOHAMED, AMBAREEN (OD)
Entity type:Individual
Prefix:DR
First Name:AMBAREEN
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BARRETT PKWY
Mailing Address - Street 2:SUITE 617
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4917
Mailing Address - Country:US
Mailing Address - Phone:770-421-1734
Mailing Address - Fax:770-421-0319
Practice Address - Street 1:400 BARRETT PKWY
Practice Address - Street 2:SUITE 617
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4917
Practice Address - Country:US
Practice Address - Phone:770-421-1734
Practice Address - Fax:770-421-0319
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist