Healthcare Provider Details

I. General information

NPI: 1871176305
Provider Name (Legal Business Name): ELHAM VAHHAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

2202 MARIETTA BLVD NW APT 428
ATLANTA GA
30318-2269
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-4000
  • Fax:
Mailing address:
  • Phone: 469-271-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number111654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: