Healthcare Provider Details

I. General information

NPI: 1710199831
Provider Name (Legal Business Name): NADER A DBOUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MILSTEAD RD NE SUITE 120
CONYERS GA
30012
US

IV. Provider business mailing address

1355 PEACHTREE ST NE STE 1600
ATLANTA GA
30309-3276
US

V. Phone/Fax

Practice location:
  • Phone: 678-745-3033
  • Fax: 678-745-3034
Mailing address:
  • Phone: 678-223-7774
  • Fax: 678-223-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number48577
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number065757
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number48577
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number065757
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: