Basic Information
| Provider Information | |||||||||
| NPI: | 1336656123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURAD | ||||||||
| FirstName: | MAMOUD | ||||||||
| MiddleName: | WATFER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102966 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303682966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786041053 | ||||||||
| FaxNumber: | 6786045548 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 EAGLES LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786041053 | ||||||||
| FaxNumber: | 6786045548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2018 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0000X | RN223533 | GA | N | Nursing Service Providers | Registered Nurse | Pain Management | 163W00000X | RN223533 | GA | N | Nursing Service Providers | Registered Nurse | 367500000X | RN223533 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.