Provider Demographics
NPI:1194239210
Name:KATOOT, ABDULLAH OMAR
Entity type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:OMAR
Last Name:KATOOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 LAURIAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7304
Mailing Address - Country:US
Mailing Address - Phone:404-444-1314
Mailing Address - Fax:
Practice Address - Street 1:907 BUFORD RD STE 600
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2733
Practice Address - Country:US
Practice Address - Phone:404-444-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0282651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist