Active NPI
Ibtisam Mohammad
- Otolaryngology Physician
- Augusta, GA
National Provider Identifier
1356239305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 18013
- Practice address
- 1120 15TH St # BP-4109
Augusta, GA 30912-0006 - Phone
- (706) 721-6100
- NPI assigned
- Jun 26, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 18013 | GA | Primary |
Addresses
Primary practice location
1120 15TH St # BP-4109
Augusta, GA 30912-0006
Mailing address
1120 15TH St # BP-4109
Augusta, GA 30912-0006
Phone (706) 721-6100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18013 | GA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1356239305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 15TH ST # BP-4109",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120006",
"telephone_number": "706-721-6100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST # BP-4109",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120006",
"telephone_number": "706-721-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMMAD",
"first_name": "IBTISAM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-26",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "GA",
"license": "18013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.