Provider Demographics
NPI:1467434373
Name:HABACH, GHAYAS ALI (MD, MPH)
Entity Type:Individual
Prefix:
First Name:GHAYAS
Middle Name:ALI
Last Name:HABACH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2038
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-5038
Mailing Address - Country:US
Mailing Address - Phone:256-249-0028
Mailing Address - Fax:256-249-0019
Practice Address - Street 1:291 JAMES PAYTON BLVD
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-8047
Practice Address - Country:US
Practice Address - Phone:256-249-0028
Practice Address - Fax:256-249-0019
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17714207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536235OtherBCBS - CBURG
AL529927850Medicaid
51504549OtherBC/BS - SYLACAUGA
51517000OtherBC/BS - GOODWATER
51524305OtherBC/BS - CITIZENS HOSPITAL
AL543928002Medicaid
AL009939531Medicaid
AL529908510Medicaid
AL009974915Medicaid
AL009974925Medicaid
51523146OtherBC/BS - LANDMARK DIALYSIS
AL51536048OtherBCBS TALL CLINIC
AL540003928Medicaid
AL000077420Medicaid
AL009940116Medicaid
000077420Medicare ID - Type Unspecified
AL009939531Medicaid
AL543928002Medicaid