Provider Demographics
NPI:1598883928
Name:ELKABBANI, SHARIF FIESAL (MD)
Entity Type:Individual
Prefix:
First Name:SHARIF
Middle Name:FIESAL
Last Name:ELKABBANI
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:PO BOX 7695
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-7695
Mailing Address - Country:US
Mailing Address - Phone:706-389-3410
Mailing Address - Fax:706-389-3411
Practice Address - Street 1:1230 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-389-3410
Practice Address - Fax:706-389-3411
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059912207R00000X, 208M00000X
OH35.089439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA405271OtherWELLCARE
GA889267212GMedicaid
GA9319080OtherAETNA
GA2836617OtherUHC
GA10066938OtherAMERIGROUP
GA5147641OtherCIGNA
GAP00465763OtherMEDICARE RAILROAD CARRIER, PALMETTO GBA
GA889267212BMedicaid
GA889267212AOtherPEACH STATE
GA889267212AMedicaid
GA52206175OtherBCBS
GA889267212AOtherPEACH STATE
GAP00465763OtherMEDICARE RAILROAD CARRIER, PALMETTO GBA
GA889267212AMedicaid