Provider Demographics
NPI:1639449416
Name:ANBA ABRAAM MEDICAL CLINIC
Entity Type:Organization
Organization Name:ANBA ABRAAM MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAWFIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-670-1718
Mailing Address - Street 1:555 BELL RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2001
Mailing Address - Country:US
Mailing Address - Phone:910-670-1718
Mailing Address - Fax:615-365-3443
Practice Address - Street 1:555 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2001
Practice Address - Country:US
Practice Address - Phone:910-670-1718
Practice Address - Fax:615-365-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty