Provider Demographics
NPI:1598836074
Name:ELAMIN, NAGWA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAGWA
Middle Name:
Last Name:ELAMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 BELMONT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2005
Mailing Address - Country:US
Mailing Address - Phone:770-539-9110
Mailing Address - Fax:
Practice Address - Street 1:655 JESSE JEWELL PKWY SE
Practice Address - Street 2:# E
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3756
Practice Address - Country:US
Practice Address - Phone:770-539-9110
Practice Address - Fax:770-539-9133
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390489607AMedicaid