Provider Demographics
NPI:1821173121
Name:ABU HATAB, MAZEN AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:AHMAD
Last Name:ABU HATAB
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 32786
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930
Mailing Address - Country:US
Mailing Address - Phone:865-692-9111
Mailing Address - Fax:865-692-9191
Practice Address - Street 1:8044 RAY MEARS BLVD
Practice Address - Street 2:STE 116
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-692-9111
Practice Address - Fax:865-692-9191
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28777207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827744Medicaid
F71690Medicare UPIN
TN3827744Medicaid