Provider Demographics
NPI:1831299726
Name:MADI, RABII (MD)
Entity Type:Individual
Prefix:
First Name:RABII
Middle Name:
Last Name:MADI
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 1:1499 WALTON WAY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2602
Mailing Address - Country:US
Mailing Address - Phone:706-724-6100
Mailing Address - Fax:706-724-1600
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4785208800000X
OH35.094639208800000X
GA067062208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00880292OtherRAILROAD MEDICARE
ARP00365084OtherRAILROAD MEDICARE
AR06070017400OtherQUALCHOICE
OH536754OtherWELLCARE
OH2511107Medicaid
AR162839001Medicaid
OHP00880292OtherRAILROAD MEDICARE
OH2511107Medicaid
OHMA4282031Medicare PIN