Provider Demographics
NPI:1043287832
Name:SAMADY, HABIB (MD)
Entity Type:Individual
Prefix:DR
First Name:HABIB
Middle Name:
Last Name:SAMADY
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-534-2020
Practice Address - Fax:770-534-8025
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840564207RC0000X
GA055968207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010132649Medicaid
GA226452Medicaid
VA5115977OtherUHC/MAMSI/MDIPA
VAPAROtherCORVEL COR CARE
VA004769E30Medicare ID - Type UnspecifiedVA MEDICARE
VAF61352Medicare UPIN
VAPAROtherVHN/PHCS
VAPAROtherFIRST HEALTH
VAPAROtherVPH
VAPAROtherCIGNA
VAPAROtherMID-ATLANTIC VICARE
VA75117OtherSENTARA OHP/SHP
VAPAROtherAETNA PPO
VAPAROtherMULTI PLAN
VAPAROtherUSA MANAGED CARE
VAP00141365Medicare ID - Type UnspecifiedVA RR MCR