Healthcare Provider Details

I. General information

NPI: 1912109505
Provider Name (Legal Business Name): NURUL I. HOQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 PARKLAKE DR NE STE 385
ATLANTA GA
30345-2896
US

IV. Provider business mailing address

PO BOX 1648
DECATUR GA
30031-1648
US

V. Phone/Fax

Practice location:
  • Phone: 678-656-2232
  • Fax: 678-623-5662
Mailing address:
  • Phone: 404-508-3835
  • Fax: 404-294-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP44544
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0800304
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: