Provider Demographics
NPI:1164692174
Name:KANAAN, USAMA B (MD)
Entity Type:Individual
Prefix:
First Name:USAMA
Middle Name:B
Last Name:KANAAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2835 BRANDYWINE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5540
Mailing Address - Country:US
Mailing Address - Phone:404-256-2593
Mailing Address - Fax:678-547-1494
Practice Address - Street 1:1400 TULLIE RD NE STE 630
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-256-2593
Practice Address - Fax:678-547-1494
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2021-01-22
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Provider Licenses
StateLicense IDTaxonomies
GA0606482080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA367158412HMedicaid