Healthcare Provider Details

I. General information

NPI: 1104858794
Provider Name (Legal Business Name): AHMAD S AL-DABAGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 170
DULUTH GA
30096-5145
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1911
  • Fax: 810-733-8135
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301063880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: