Provider Demographics
NPI:1356427850
Name:KABAKIBOU, KAMAL C (MD)
Entity type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:C
Last Name:KABAKIBOU
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 1:3193 HOWELL MILL RD NW
Mailing Address - Street 2:STE. #317
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2119
Mailing Address - Country:US
Mailing Address - Phone:404-603-9090
Mailing Address - Fax:404-603-9634
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:STE. #317
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-603-9090
Practice Address - Fax:404-603-9634
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG39860Medicare UPIN
GA05BDHBGMedicare ID - Type UnspecifiedMEDICARE ID