Healthcare Provider Details

I. General information

NPI: 1043836562
Provider Name (Legal Business Name): SYED ABDUL-RAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 DULUTH HWY STE B
DULUTH GA
30097-4007
US

IV. Provider business mailing address

2145 DULUTH HWY STE B
DULUTH GA
30097-4007
US

V. Phone/Fax

Practice location:
  • Phone: 678-866-1050
  • Fax:
Mailing address:
  • Phone: 678-866-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number111424
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN123651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: