Active NPI
Ahmed Abdul Koudous, RPH
- Pharmacist
- Conyers, GA
National Provider Identifier
1376157008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH030902
- Practice address
- 1783 Highway 138 SE
Conyers, GA 30013-1295 - Phone
- (770) 483-5644
- Fax
- (770) 483-3880
- NPI assigned
- Sep 1, 2020
- Last updated
- Sep 1, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH030902 | GA | Primary |
Addresses
Primary practice location
1783 Highway 138 SE
Conyers, GA 30013-1295
Mailing address
1783 Highway 138 SE
Conyers, GA 30013-1295
Phone (770) 483-5644
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH030902 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1783 Highway 138 SE
Conyers, GA 30013
Phone (770) 483-5644
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1376157008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1783 HIGHWAY 138 SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300131295",
"telephone_number": "770-483-5644",
"fax_number": "770-483-3880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1783 HIGHWAY 138 SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300131295",
"telephone_number": "770-483-5644",
"fax_number": "770-483-3880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUDOUS",
"first_name": "AHMED",
"middle_name": "ABDUL",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-01",
"last_updated": "2020-09-01",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH030902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.