Provider Demographics
NPI:1114066602
Name:BANEGURA, FABIO KATUREEBE (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:KATUREEBE
Last Name:BANEGURA
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 1:4124 HIGHWAY 278 NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2494
Mailing Address - Country:US
Mailing Address - Phone:770-786-5000
Mailing Address - Fax:
Practice Address - Street 1:4124 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2494
Practice Address - Country:US
Practice Address - Phone:770-786-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021447207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABB0398582OtherDEA#
GAD7618Medicare UPIN