Provider Demographics
NPI:1407911647
Name:CABANAS, ISRAEL J JR
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:J
Last Name:CABANAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 MEMORIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3239
Mailing Address - Country:US
Mailing Address - Phone:404-292-5676
Mailing Address - Fax:404-299-8657
Practice Address - Street 1:5462 MEMORIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3239
Practice Address - Country:US
Practice Address - Phone:404-292-5676
Practice Address - Fax:404-299-8657
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG19113Medicare UPIN