Provider Demographics
NPI:1104861921
Name:GHORAYEB, ERIC G (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:GHORAYEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 834
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6737
Mailing Address - Country:US
Mailing Address - Phone:770-399-6262
Mailing Address - Fax:
Practice Address - Street 1:6850 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 834
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6737
Practice Address - Country:US
Practice Address - Phone:770-399-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10BDHKDMedicare ID - Type Unspecified
F46535Medicare UPIN