Provider Demographics
NPI:1801911334
Name:YOUSSOUFIAN, HAGOP (MD)
Entity type:Individual
Prefix:DR
First Name:HAGOP
Middle Name:
Last Name:YOUSSOUFIAN
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 1:150 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2543
Mailing Address - Country:US
Mailing Address - Phone:800-998-5859
Mailing Address - Fax:404-378-7460
Practice Address - Street 1:150 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2543
Practice Address - Country:US
Practice Address - Phone:800-998-5859
Practice Address - Fax:404-378-7460
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6424207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF17617Medicare UPIN
NJY0088T446Medicare ID - Type Unspecified