Provider Demographics
NPI:1831374453
Name:ABBOUSHI, NOUR (MD)
Entity type:Individual
Prefix:DR
First Name:NOUR
Middle Name:
Last Name:ABBOUSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1368 WELLBROOK CIR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3949
Mailing Address - Country:US
Mailing Address - Phone:770-929-0634
Mailing Address - Fax:770-929-8716
Practice Address - Street 1:1368 WELLBROOK CIR NE
Practice Address - Street 2:SUITE B
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3949
Practice Address - Country:US
Practice Address - Phone:770-929-0634
Practice Address - Fax:770-929-8716
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA090965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I023001Medicare PIN