Provider Demographics
NPI:1205839891
Name:GHIATHI, ABDOLLATIF SALEH (DO)
Entity Type:Individual
Prefix:
First Name:ABDOLLATIF
Middle Name:SALEH
Last Name:GHIATHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-5829
Mailing Address - Country:US
Mailing Address - Phone:229-732-3721
Mailing Address - Fax:229-732-6536
Practice Address - Street 1:125 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-5829
Practice Address - Country:US
Practice Address - Phone:229-732-3721
Practice Address - Fax:229-732-6536
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00680688FMedicaid
GAG17338Medicare UPIN
GA00680688FMedicaid