Healthcare Provider Details

I. General information

NPI: 1912203829
Provider Name (Legal Business Name): ASRA BATOOL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 ROSWELL RD STE 318
MARIETTA GA
30062-6227
US

IV. Provider business mailing address

3747 ROSWELL RD STE 318
MARIETTA GA
30062-6227
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-1520
  • Fax: 770-999-2673
Mailing address:
  • Phone: 470-267-1520
  • Fax: 770-999-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: