Provider Demographics
NPI:1851094858
Name:ATASSI, OMAR
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:ATASSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 A ST APT 701
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3465
Mailing Address - Country:US
Mailing Address - Phone:440-667-9476
Mailing Address - Fax:
Practice Address - Street 1:1601 W 40TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6069
Practice Address - Country:US
Practice Address - Phone:870-541-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program