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General NPI Number Information
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NPI Number | 1588815674
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Entity Type | Individual
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Provider Name | ISLAM G ELTARAWY MD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 97 HEFNER ST SUITE 202
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-8268
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Country | US
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Telephone | 706-635-1400
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Fax | 706-635-1411
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Provider Business Mailing Address
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Address Line | 9766 HIGHWAY 92 SUITE 200
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City | WOODSTOCK
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State | GA
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Zip | 30188-6455
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Country | US
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Telephone | 770-926-8717
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Fax | 770-916-4820
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53261
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 065104
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License Number State | GA
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