Provider Demographics
NPI:1235119207
Name:EL-ATTAR, MOHAMAD (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:
Last Name:EL-ATTAR
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 1:1372 WELLBROOK CIRCLE NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012
Mailing Address - Country:US
Mailing Address - Phone:770-483-2368
Mailing Address - Fax:770-785-2489
Practice Address - Street 1:1372 WELLBROOK CIRCLE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:770-483-2368
Practice Address - Fax:770-785-2489
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00707066DMedicaid
GA000707066DMedicaid
GA00707066DMedicaid
GAF33718Medicare UPIN