Provider Demographics
NPI:1275755928
Name:HREIBE, HAITHAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:M
Last Name:HREIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAITHAM
Other - Middle Name:M
Other - Last Name:HREYBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1499 WALTON WAY STE. 1400
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-724-6100
Mailing Address - Fax:706-724-1600
Practice Address - Street 1:1120 15TH STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:814-643-4010
Practice Address - Fax:814-643-8135
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439371207R00000X, 207RC0000X, 207RC0001X
GA001880207RC0000X
GA076585207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025260980001Medicaid
PA1025260980001Medicaid