Healthcare Provider Details

I. General information

NPI: 1770151227
Provider Name (Legal Business Name): ABDALLAH YOUSEF SULEIMAN ALMEGDADI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date: 12/01/2022
Reactivation Date: 12/01/2022

III. Provider practice location address

1551 DOCTORS DR
LAGRANGE GA
30240-4139
US

IV. Provider business mailing address

1551 DOCTORS DR
LAGRANGE GA
30240-4139
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-7490
  • Fax: 770-999-2819
Mailing address:
  • Phone: 706-803-7490
  • Fax: 770-999-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number104594
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: