Healthcare Provider Details

I. General information

NPI: 1851094858
Provider Name (Legal Business Name): DR. OMAR ATASSI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CLUB MANOR SUITE 2B, MAUMELLE, 72113
MAUMELLE AR
72113
US

IV. Provider business mailing address

100 BILL HEGEMAN BLVD APT S101
CONWAY AR
72032-6043
US

V. Phone/Fax

Practice location:
  • Phone: 501-851-7402
  • Fax: 501-851-4753
Mailing address:
  • Phone: 440-667-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-19165
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: