1376541078 NPI number — AZMI A KABBANI MD

Table of content: AZMI A KABBANI MD (NPI 1376541078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376541078 NPI number — AZMI A KABBANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KABBANI
Provider First Name:
AZMI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376541078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-745-5455
Provider Business Mailing Address Fax Number:
478-745-2915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-745-5455
Provider Business Practice Location Address Fax Number:
478-745-2915
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  31171 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000459445AE , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AJ , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AK , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AL , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110063832 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000459445AI , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AD , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445P , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028816 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000459445Z , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AG , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AH , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445AF , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000459445M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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