Provider Demographics
NPI:1740267806
Name:NASSAR, AHMED MOSTAFA (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOSTAFA
Last Name:NASSAR
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 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:SUITE 616
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-766-6626
Mailing Address - Fax:404-766-6260
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 616
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-766-6626
Practice Address - Fax:404-766-6260
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA971776772Medicaid
GAP00479394OtherRAIL ROAD MEDICARE
GA511G700210Medicare PIN
GAP00479394OtherRAIL ROAD MEDICARE
GA971776772Medicaid