Provider Demographics
NPI:1609056480
Name:NASSAR ENTERPRISES,LLC
Entity Type:Organization
Organization Name:NASSAR ENTERPRISES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-766-6268
Mailing Address - Street 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:SUITE 616
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-766-6268
Mailing Address - Fax:
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 616
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7116
Practice Address - Country:US
Practice Address - Phone:404-766-6268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA971776772BMedicaid
GAP00479394OtherRAIL ROAD MEDICARE
GAI05650Medicare UPIN
GA971776772BMedicaid
GA6111490001Medicare NSC