Provider Demographics
NPI:1710199831
Name:DBOUK, NADER A (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:A
Last Name:DBOUK
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 1:1355 PEACHTREE ST NE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3276
Mailing Address - Country:US
Mailing Address - Phone:678-223-7774
Mailing Address - Fax:678-223-7799
Practice Address - Street 1:1501 MILSTEAD RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:678-745-3033
Practice Address - Fax:678-745-3034
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48577207RG0100X, 207RT0003X
GA065757207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176404AMedicaid
MS02304007Medicaid
TN1529666Medicaid
TNP01288705OtherRAILROAD MEDICARE
AR193868001Medicaid
TN1529666Medicaid