Fouad Victor Atalla, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

33744 Issued in KY

Practice address

1048 Ashley St Ste 303
Bowling Green, KY 42103-2451

Phone

(270) 796-8960

Fax

(270) 842-5683

NPI assigned

Sep 27, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Center for Plastic & Reconstructive Surgery PSC

  • Plastic and Reconstructive Surgery Physician
  • Bowling Green, KY
  • NPI 1710084827

  KY, Plastic and Reconstructive Surgery

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1063408771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 ASHLEY ST STE 303",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032451",
            "telephone_number": "270-796-8960",
            "fax_number": "270-842-5683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 ASHLEY ST STE 303",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032451",
            "telephone_number": "270-796-8960",
            "fax_number": "270-842-5683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATALLA",
        "first_name": "FOUAD",
        "middle_name": "VICTOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "KY",
            "license": "33744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64337447",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Assuredlink Case Management Agency
• At Home Care of Kentucky, Inc
• At Home Care of Kentucky, Inc
• At Home Care of Kentucky, Inc.
• Kasey Atack
• Marcia Atherton, APRN FNP-C
• Amanda E Atkinson, MSN, RN
• Shannon M Atkinson, APRN
• Camdyn Atwell
• Sydney Atwell

• All providers in Bowling Green, KY
• Plastic and Reconstructive Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.