Provider Demographics
NPI:1760579981
Name:ABDUL BARI M.D ,INC
Entity Type:Organization
Organization Name:ABDUL BARI M.D ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-377-7090
Mailing Address - Street 1:618 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2228
Mailing Address - Country:US
Mailing Address - Phone:229-377-7090
Mailing Address - Fax:229-377-6936
Practice Address - Street 1:618 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2228
Practice Address - Country:US
Practice Address - Phone:229-377-7090
Practice Address - Fax:229-377-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00769271EMedicaid
GA1659324994OtherINDIVIDUAL NPI
GA1659324994OtherINDIVIDUAL NPI
GA00769271EMedicaid