Provider Demographics
NPI:1699062133
Name:GHAZAL, NADER (MD)
Entity type:Individual
Prefix:MR
First Name:NADER
Middle Name:
Last Name:GHAZAL
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 1:1500 PEACHTREE INDUSTRIAL BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8489
Mailing Address - Country:US
Mailing Address - Phone:470-266-1522
Mailing Address - Fax:470-266-1455
Practice Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8489
Practice Address - Country:US
Practice Address - Phone:470-266-1522
Practice Address - Fax:470-266-1455
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71943207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103I206779Medicare PIN