MEDICARE: DR. HISHAM FOZI QUTOB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	86852	GA
2	207RP1001X	Pulmonary Disease Physician	86852	GA

General Provider Information

NPI Number	:	1578723177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HISHAM FOZI QUTOB M.D.

Provider Business Mailing Address
First Line	:	1505 NORTHSIDE BLVD STE 3500
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-8223
Country	:	US
Telephone Number	:	770-292-3120
Fax Number	:	770-292-3121

Provider Business Practice Location Address
First Line	:	1505 NORTHSIDE BLVD STE 3500
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-8223
Country	:	US
Telephone Number	:	770-292-3120
Fax Number	:	770-292-3121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	04/04/2026

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