Provider Demographics
NPI:1194727479
Name:ATASSI, NAWAF GHATFAN (MD)
Entity type:Individual
Prefix:DR
First Name:NAWAF
Middle Name:GHATFAN
Last Name:ATASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NAWAF
Other - Middle Name:GHATFAN
Other - Last Name:ATASSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:608A AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8210
Mailing Address - Country:US
Mailing Address - Phone:252-523-8513
Mailing Address - Fax:252-317-2096
Practice Address - Street 1:608A AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8210
Practice Address - Country:US
Practice Address - Phone:252-523-8513
Practice Address - Fax:252-317-2096
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35832207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891214MMedicaid
NC891214MMedicaid
2186067GMedicare ID - Type Unspecified