Provider Demographics
NPI:1154685550
Name:ELFASI, ABDULJALIL (MD)
Entity Type:Individual
Prefix:
First Name:ABDULJALIL
Middle Name:
Last Name:ELFASI
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 1:39 KENT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1697
Mailing Address - Country:US
Mailing Address - Phone:229-391-4310
Mailing Address - Fax:
Practice Address - Street 1:39 KENT RD STE 1
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1697
Practice Address - Country:US
Practice Address - Phone:229-391-4310
Practice Address - Fax:229-391-4243
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76709207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology