Healthcare Provider Details

I. General information

NPI: 1659759207
Provider Name (Legal Business Name): EBTISAM MOHAMMED ALUMIN OSMAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

780 CANTON RD NE STE 400
MARIETTA GA
30060-7298
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-1452
  • Fax:
Mailing address:
  • Phone: 770-422-3602
  • 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 Code2084N0400X
TaxonomyNeurology Physician
License Number84013
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: