Provider Demographics
NPI:1588815674
Name:ELTARAWY, ISLAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:ISLAM
Middle Name:G
Last Name:ELTARAWY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9766 HIGHWAY 92
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6455
Mailing Address - Country:US
Mailing Address - Phone:770-926-8717
Mailing Address - Fax:770-916-4820
Practice Address - Street 1:97 HEFNER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8268
Practice Address - Country:US
Practice Address - Phone:706-635-1400
Practice Address - Fax:706-635-1411
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2016-05-16
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Provider Licenses
StateLicense IDTaxonomies
WI53261207Q00000X
GA065104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2733OtherTEP