Provider Demographics
NPI:1497173017
Name:MASABNI, KHALIL (MD)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:MASABNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2825
Mailing Address - Country:US
Mailing Address - Phone:478-743-9762
Mailing Address - Fax:478-743-9465
Practice Address - Street 1:575 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2825
Practice Address - Country:US
Practice Address - Phone:478-743-9762
Practice Address - Fax:478-743-9465
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA884002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery