Provider Demographics
NPI:1447000476
Name:ABDALLAH, MOSTAFA (MBBS)
Entity type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2529
Mailing Address - Country:US
Mailing Address - Phone:706-226-8996
Mailing Address - Fax:706-272-6761
Practice Address - Street 1:1432 BROADRICK DRIVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:706-226-8990
Practice Address - Fax:706-529-5317
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16858390200000X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program