Provider Demographics
NPI:1174502694
Name:ABDULLA, ABDULLA M (MD)
Entity Type:Individual
Prefix:
First Name:ABDULLA
Middle Name:M
Last Name:ABDULLA
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 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5108
Mailing Address - Country:US
Mailing Address - Phone:706-724-8611
Mailing Address - Fax:706-821-8100
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 5100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5108
Practice Address - Country:US
Practice Address - Phone:706-724-8611
Practice Address - Fax:706-821-8100
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D39248Medicare UPIN
GAGRP3804Medicare ID - Type Unspecified