Provider Demographics
NPI:1033165048
Name:HOSSAM E FADEL, MD, PC
Entity Type:Organization
Organization Name:HOSSAM E FADEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FADEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-724-2148
Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 5500
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5104
Mailing Address - Country:US
Mailing Address - Phone:706-724-2148
Mailing Address - Fax:706-724-1908
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 5500
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-724-2148
Practice Address - Fax:706-724-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID