Provider Demographics
NPI:1770610115
Name:DANNER, OMAR KARREIM (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:KARREIM
Last Name:DANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE NE
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2544
Mailing Address - Country:US
Mailing Address - Phone:404-756-5271
Mailing Address - Fax:404-756-1402
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:MSM DEPARTMENT OF SURGERY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-1415
Practice Address - Fax:404-616-1417
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61837208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901194Medicaid
NC2037961Medicare ID - Type Unspecified
NC5901194Medicaid