Provider Demographics
NPI:1386192383
Name:AWWAD, RAFAK
Entity Type:Individual
Prefix:
First Name:RAFAK
Middle Name:
Last Name:AWWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2188 STEPHENS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4327
Mailing Address - Country:US
Mailing Address - Phone:678-292-6230
Mailing Address - Fax:
Practice Address - Street 1:2188 STEPHENS DR
Practice Address - Street 2:SUITE A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4327
Practice Address - Country:US
Practice Address - Phone:678-292-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059119434341600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)