Provider Demographics
NPI:1972588416
Name:MUHANNA, NABIL LUTFI (MD)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:LUTFI
Last Name:MUHANNA
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 1:2128 VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1237
Mailing Address - Country:US
Mailing Address - Phone:678-206-3204
Mailing Address - Fax:
Practice Address - Street 1:655 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3854
Practice Address - Country:US
Practice Address - Phone:770-533-7288
Practice Address - Fax:770-534-9800
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023643173000000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA558244OtherWELLCARE
GA000254812DMedicaid
GA01351948OtherAMERIGROUP
GA52053670OtherBCBS
GA000254812EMedicaid
GA558244OtherWELLCARE
GA01351948OtherAMERIGROUP