Provider Demographics
NPI:1508890518
Name:NOUR ABDALLA, SHERIF G (MD)
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:G
Last Name:NOUR ABDALLA
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 1:1364 CLIFTON RD NE
Mailing Address - Street 2:DEPT OF RADIOLOGY, SUITE BG-48
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-778-3164
Mailing Address - Fax:404-712-1871
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:DEPT OF RADIOLOGY, EUHOSPITAL, SUITE BG-48
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-1868
Practice Address - Fax:404-712-1871
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0844132085R0202X
GA0616272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503583OtherANTHEM
OH0304914OtherBCMH
OH7450447OtherAETNA
OHP00358821OtherRAILROAD MEDICARE
OH383883OtherWELLCARE
OH734995OtherBUCKEYE
OH2354205Medicaid
OH000000206507OtherUNISON
OHP00001777OtherRAILROAD MEDICARE
OHNO4146764Medicare PIN
OH0304914OtherBCMH
OH000000503583OtherANTHEM