Provider Demographics
NPI:1134336332
Name:AL-AWABDY, BASIL SALEM (MD)
Entity type:Individual
Prefix:
First Name:BASIL
Middle Name:SALEM
Last Name:AL-AWABDY
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 1:488 KENNESAW AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9409
Mailing Address - Country:US
Mailing Address - Phone:770-427-3075
Mailing Address - Fax:770-427-3261
Practice Address - Street 1:488 KENNESAW AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9409
Practice Address - Country:US
Practice Address - Phone:770-427-3075
Practice Address - Fax:770-427-3261
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68427207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126066AMedicaid