1275562175 NPI number — DR. KHALED M ABOUHAIF D.C.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275562175 NPI number — DR. KHALED M ABOUHAIF D.C.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ABOUHAIF

Provider First Name:

KHALED

Provider Middle Name:

M

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.C.

Provider Gender Code:

M

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:

1275562175

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/16/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

919 DUAL HALL CT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

POWDER SPRINGS

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30127-6970

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

770-419-1028

Provider Business Mailing Address Fax Number:

770-419-1447

Provider First Line Business Practice Location Address:

310 GOLD CREEK TRL

Provider Second Line Business Practice Location Address:

STE 100

Provider Business Practice Location Address City Name:

WOODSTOCK

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30188-5403

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

770-926-9495

Provider Business Practice Location Address Fax Number:

770-926-9284

Provider Enumeration Date:

07/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 111N00000X , with the licence number:  2301007348 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 111N00000X , with the licence number: CHIR008019 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0980481 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 350045598 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 3334395 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 133505 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 383374689 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1002612 . This is a "MCLAREN HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4400101 . This is a "PHYSICIANS HEALTHPLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1016842-0001 . This is a "WELLNESS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 5183617 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: KA007348 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".