Healthcare Provider Details

I. General information

NPI: 1952394298
Provider Name (Legal Business Name): JALAL ZUBERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 LESTER RD NW STE C
LAWRENCEVILLE GA
30044-4046
US

IV. Provider business mailing address

325 LESTER RD NW BLDG 100-A
LAWRENCEVILLE GA
30044-4024
US

V. Phone/Fax

Practice location:
  • Phone: 770-935-1515
  • Fax: 770-935-1040
Mailing address:
  • Phone: 770-935-1515
  • Fax: 770-935-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number031690
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031690
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: