Provider Demographics
NPI:1104858794
Name:AL-DABAGH, AHMAD S (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:S
Last Name:AL-DABAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3790 PLEASANT HILL RD STE 170
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5145
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:810-733-8135
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301746Medicaid
MI1102504361OtherBLUE CROSS BLUE SHIELD
MI4301746Medicaid
MI1102504361OtherBLUE CROSS BLUE SHIELD