Assam Ullah, M.D

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

11 Upper Riverdale Rd. Southern Regional Medical Center
Riverdale, GA 30274

Phone

(770) 991-8570

NPI assigned

May 3, 2024

Reactivated

Jan 16, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1811744279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD. SOUTHERN REGIONAL MEDICAL CENTER",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "30274",
            "telephone_number": "770-991-8570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD. SOUTHERN REGIONAL MEDICAL CENTER",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "30274",
            "telephone_number": "770-991-8570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLAH",
        "first_name": "ASSAM",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-03",
        "last_updated": "2025-01-16",
        "deactivation_date": "2025-01-09",
        "reactivation_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• United Physicians of Georgia, LLC
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• Student in an Organized Health Care Education/Training Program in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Student in an Organized Health Care Education/Training Program in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.

Verify at the official NPI Registry.