Provider Demographics
NPI:1407943301
Name:GHOSN, RAMZI NABIH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMZI
Middle Name:NABIH
Last Name:GHOSN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:73 PRESTIGE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6370
Mailing Address - Country:US
Mailing Address - Phone:706-265-8002
Mailing Address - Fax:706-429-0033
Practice Address - Street 1:73 PRESTIGE LN STE 103
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6370
Practice Address - Country:US
Practice Address - Phone:706-265-8002
Practice Address - Fax:706-429-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG74112Medicare UPIN
GA511I080334Medicare PIN