Provider Demographics
NPI:1134566367
Name:INFECTIOUS DISEASE CLINIC LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-284-2508
Mailing Address - Street 1:PO BOX 14485
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31203-4485
Mailing Address - Country:US
Mailing Address - Phone:478-284-2508
Mailing Address - Fax:
Practice Address - Street 1:104 BORDERS WAY STE 400
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8967
Practice Address - Country:US
Practice Address - Phone:478-333-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55016207RC0200X, 207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty