Provider Demographics
NPI:1467919035
Name:ABUJABER, AMRO
Entity Type:Individual
Prefix:
First Name:AMRO
Middle Name:
Last Name:ABUJABER
Suffix:
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 1:2558 VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7521
Mailing Address - Country:US
Mailing Address - Phone:731-935-9578
Mailing Address - Fax:
Practice Address - Street 1:2558 VINTAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7521
Practice Address - Country:US
Practice Address - Phone:731-935-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112738117344600000X
TN112738177347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No344600000XTransportation ServicesTaxi