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General NPI Number Information
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NPI Number | 1295122745
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Entity Type | Individual
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Provider Name | THAER IDREES M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 69 JESSE HILL JR DR SE STE 200
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City | ATLANTA
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State | GA
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Zip | 30303-3033
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Country | US
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Telephone | 502-548-0833
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Fax |
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Provider Business Mailing Address
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Address Line | 69 JESSE HILL JR DR SE STE 200
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City | ATLANTA
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State | GA
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Zip | 30303-3033
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Country | US
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Telephone | 502-548-0833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036143922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 86244
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License Number State | GA
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