Basic Information
| Provider Information | |||||||||
| NPI: | 1598860991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASSAR | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 PIEDMONT AVE NE | ||||||||
| Address2: | STE 700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303032544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047561403 | ||||||||
| FaxNumber: | 4047565252 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 JESSE HILL JR DR SE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046165800 | ||||||||
| FaxNumber: | 4046160787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 10/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 012848 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000409582A | 05 | GA | MEDICAID |