Healthcare Provider Details

I. General information

NPI: 1346410594
Provider Name (Legal Business Name): OMAR RAFIK KASHLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TREE LN STE 190
SNELLVILLE GA
30078-6766
US

IV. Provider business mailing address

229 PEACHTREE ST NE STE 1200
ATLANTA GA
30303-1620
US

V. Phone/Fax

Practice location:
  • Phone: 770-736-6300
  • Fax:
Mailing address:
  • Phone: 404-874-1788
  • Fax: 404-872-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301096318
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number75729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: