Provider Demographics
NPI:1124453337
Name:DOONQUAH, LADI (MD)
Entity type:Individual
Prefix:
First Name:LADI
Middle Name:
Last Name:DOONQUAH
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 1:3660 FLAT SHOALS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1649
Mailing Address - Country:US
Mailing Address - Phone:876-968-3130
Mailing Address - Fax:
Practice Address - Street 1:3660 FLAT SHOALS RD STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1649
Practice Address - Country:US
Practice Address - Phone:876-968-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40898204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery