Healthcare Provider Details

I. General information

NPI: 1851094072
Provider Name (Legal Business Name): RAMEZ JABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 DULUTH HWY STE 401
LAWRENCEVILLE GA
30046-4303
US

IV. Provider business mailing address

PO BOX 1190
LAWRENCEVILLE GA
30046-1190
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number110549
License Number StateGA
# 2
Primary TaxonomyY
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: