Provider Demographics
NPI:1548754856
Name:HASEEB, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:HASEEB
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 1:890 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6863
Mailing Address - Country:US
Mailing Address - Phone:478-745-4322
Mailing Address - Fax:478-254-3629
Practice Address - Street 1:890 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6863
Practice Address - Country:US
Practice Address - Phone:478-745-4322
Practice Address - Fax:478-254-3629
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA93031207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program