Provider Demographics
NPI:1518321108
Name:TAHA, YAMAL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:YAMAL
Middle Name:JOSE
Last Name:TAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMAL
Other - Middle Name:
Other - Last Name:TAHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICK NAME
Mailing Address - Street 1:100 6TH ST NE APT 701
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1314
Mailing Address - Country:US
Mailing Address - Phone:303-602-5183
Mailing Address - Fax:
Practice Address - Street 1:100 6TH ST NE APT 701
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1314
Practice Address - Country:US
Practice Address - Phone:303-602-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062495207P00000X
390200000X
GA85969207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029012OtherKAISER COMMERCIAL NUMBER