Individual
IKRAMULLAH AHMADANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 758-2600
(803) 253-8896
Mailing address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 758-2600
(803) 253-8896
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19633
SC
207Q00000X
Family Medicine Physician
Primary
19633
SC
207R00000X
Internal Medicine Physician
052675
GA
207R00000X
Internal Medicine Physician
19633
SC
208D00000X
General Practice Physician
052675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
520862907B
—
GA
05
—
520862907C
—
GA
05
—
520862907E
—
GA
05
—
520862907F
—
GA
05
—
520862907G
—
GA
01
—
581762046
GROUP TAX I.D.- GA CLINIC
GA
Enumeration date
05/27/2006
Last updated
11/05/2009
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