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General NPI Number Information
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NPI Number | 1609056480
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Entity Type | Organization
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Legal Business Name | NASSAR ENTERPRISES,LLC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 777 CLEVELAND AVE SW SUITE 616
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City | ATLANTA
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State | GA
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Zip | 30315-7116
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Country | US
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Telephone | 404-766-6268
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Fax |
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Provider Business Mailing Address
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Address Line | 777 CLEVELAND AVE SW SUITE 616
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City | ATLANTA
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State | GA
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Zip | 30315-7129
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Country | US
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Telephone | 404-766-6268
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. AHMED NASSAR
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Credential | M.D.
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Telephone | 404-766-6268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 054428
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License Number State | GA
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