Provider Demographics
NPI:1851474795
Name:HUSSAIN, ISHRAT A (MD)
Entity Type:Individual
Prefix:
First Name:ISHRAT
Middle Name:A
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 EAGLES POINTE PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6379
Mailing Address - Country:US
Mailing Address - Phone:770-474-6969
Mailing Address - Fax:770-474-6996
Practice Address - Street 1:125 EAGLES POINTE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6379
Practice Address - Country:US
Practice Address - Phone:770-474-6969
Practice Address - Fax:770-474-6996
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12306Medicare UPIN