Provider Demographics
NPI:1255170619
Name:MULAFFER, MOHAMED THARIQ (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:THARIQ
Last Name:MULAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 15TH STREET, DEPARTMENT OF FAMILY AND COMMUNITY
Mailing Address - Street 2:HB 300E
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:706-721-4924
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH STREET, DEPARTMENT OF FAMILY AND COMMUNITY
Practice Address - Street 2:HB 300E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program