Individual
AMIRA BOULOS FANOUS-PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3000 HOSPITAL BLVD, ROSWELL, GA 30076
(770) 751-2500
Mailing address
3000 HOSPITAL BLVD, ROSWELL, GA 30076-4915
(770) 751-2500
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
77475
GA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
38616
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177879701
—
TX
Enumeration date
03/22/2006
Last updated
09/26/2019
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