Provider Demographics
NPI:1801854641
Name:EL ETR, ABDULHAFIZ M (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDULHAFIZ
Middle Name:M
Last Name:EL ETR
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:1480 E 3RD ST BLDG B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2434
Practice Address - Country:US
Practice Address - Phone:423-648-4995
Practice Address - Fax:423-648-4997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN406122084N0400X
TN406122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3338973Medicaid
TN40612OtherTN MEDICAL LICENSE
TN4130151OtherBCBS
GA54485OtherGA MEDICAL LICENSE
TN3338973Medicaid
GA54485OtherGA MEDICAL LICENSE