Provider Demographics
NPI:1295847366
Name:EL-KEBBI, IMAD MOHAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:MOHAMAD
Last Name:EL-KEBBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 775
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-367-3210
Mailing Address - Fax:404-367-3215
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 775
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-367-3210
Practice Address - Fax:404-367-3215
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA32176207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF31880Medicare UPIN
GA11SCHPDMedicare PIN
GA000505821EMedicaid