Provider Demographics
NPI:1083690515
Name:MIKHAIL, ASHRAF GB (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:GB
Last Name:MIKHAIL
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 1:200 TARPON TRAIL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5266
Mailing Address - Country:US
Mailing Address - Phone:910-938-1114
Mailing Address - Fax:910-938-1118
Practice Address - Street 1:200 TARPON TRAIL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5266
Practice Address - Country:US
Practice Address - Phone:910-938-1114
Practice Address - Fax:910-938-1118
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002004182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891335UMedicaid
NC20162728Medicare ID - Type Unspecified
NC891335UMedicaid