Basic Information
| Provider Information | |||||||||
| NPI: | 1235119207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EL-ATTAR | ||||||||
| FirstName: | MOHAMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1372 WELLBROOK CIRCLE NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704832368 | ||||||||
| FaxNumber: | 7707852489 | ||||||||
| Practice Location | |||||||||
| Address1: | 1372 WELLBROOK CIRCLE NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704832368 | ||||||||
| FaxNumber: | 7707852489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 041286 | GA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00707066D | 05 | GA | MEDICAID | 000707066D | 05 | GA | MEDICAID |