Provider Demographics
NPI:1770067506
Name:WAHAB, ABDUL (PHD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:WAHAB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 CLUBHOUSE CIR E APT A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2006
Mailing Address - Country:US
Mailing Address - Phone:470-265-2609
Mailing Address - Fax:
Practice Address - Street 1:3517 CLUBHOUSE CIR E APT A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2006
Practice Address - Country:US
Practice Address - Phone:470-265-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist