Provider Demographics
NPI:1356936942
Name:AL-GURAIRE, ATHBAH
Entity type:Individual
Prefix:
First Name:ATHBAH
Middle Name:
Last Name:AL-GURAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ATHBAH
Other - Middle Name:
Other - Last Name:AL-GURAIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7065 DEVONHALL WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7129
Mailing Address - Country:US
Mailing Address - Phone:405-351-0720
Mailing Address - Fax:
Practice Address - Street 1:1455 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-7607
Practice Address - Country:US
Practice Address - Phone:706-782-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH30058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist