Provider Demographics
NPI:1134119464
Name:HUQUE, ETESHAMUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ETESHAMUL
Middle Name:
Last Name:HUQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6095 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5607
Mailing Address - Country:US
Mailing Address - Phone:770-920-2255
Mailing Address - Fax:770-920-9963
Practice Address - Street 1:6095 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5607
Practice Address - Country:US
Practice Address - Phone:770-920-2255
Practice Address - Fax:770-920-9963
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics