Individual
MARIAM IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2614 E MADISON DR, ATLANTA, GA 30360-2027
(770) 906-0780
Mailing address
2614 E MADISON DR, ATLANTA, GA 30360-2027
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN123616
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2024
Last updated
10/10/2024
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