Healthcare Provider Details

I. General information

NPI: 1700414687
Provider Name (Legal Business Name): DEEMA KAMAL ABDEL HAMID AL-SOURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 NEWNAN CROSSING BLVD E STE 210
NEWNAN GA
30265-2576
US

IV. Provider business mailing address

110 IRVING ST NW DEPT OF
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-7800
  • Fax:
Mailing address:
  • Phone: 202-877-8278
  • Fax: 202-877-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number110717
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: