Provider Demographics
NPI:1689658742
Name:MOLOUKI, HENRY H (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:H
Last Name:MOLOUKI
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 1:550 PEACHTREE ST., NE
Mailing Address - Street 2:SUITE 1625
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-577-5863
Mailing Address - Fax:404-588-2805
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:STE. 1625
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-577-5863
Practice Address - Fax:404-588-2805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00945238AMedicaid
11BDVNCMedicare ID - Type Unspecified
GA00945238AMedicaid