Provider Demographics
NPI:1760466551
Name:ABDRABBO, FAWAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FAWAZ
Middle Name:
Last Name:ABDRABBO
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 1:576 HIGHLAND COLONY PKWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8769
Mailing Address - Country:US
Mailing Address - Phone:601-853-2676
Mailing Address - Fax:601-853-9535
Practice Address - Street 1:576 HIGHLAND COLONY PKWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8769
Practice Address - Country:US
Practice Address - Phone:601-853-0913
Practice Address - Fax:601-853-9535
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS162832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120960Medicaid
MS0120960Medicaid
G96432Medicare UPIN