Provider Demographics
NPI:1396876835
Name:EL OSTA, BADI (MD)
Entity type:Individual
Prefix:
First Name:BADI
Middle Name:
Last Name:EL OSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BADI
Other - Middle Name:EDMOND
Other - Last Name:EL OSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1105 NASH SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1731
Mailing Address - Country:US
Mailing Address - Phone:832-369-0125
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076525207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA076525OtherMEDICAL LICENSE
TXM4052OtherMEDICAL LICENSE
IL036-117338OtherLIC PHY AND SURGEON