Provider Demographics
NPI:1376541078
Name:KABBANI, AZMI A (MD)
Entity type:Individual
Prefix:
First Name:AZMI
Middle Name:A
Last Name:KABBANI
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 1:640 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3206
Mailing Address - Country:US
Mailing Address - Phone:478-745-5455
Mailing Address - Fax:478-745-2915
Practice Address - Street 1:640 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3206
Practice Address - Country:US
Practice Address - Phone:478-745-5455
Practice Address - Fax:478-745-2915
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31171207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000459445AEMedicaid
GA000459445AJMedicaid
GA000459445AKMedicaid
GA000459445ALMedicaid
110063832OtherRAILROAD MEDICARE
GA000459445AIMedicaid
GA000459445CMedicaid
GA000459445ADMedicaid
GA000459445BMedicaid
GA000459445PMedicaid
028816OtherBLUE CROSS
GA000459445ZMedicaid
GA000459445AGMedicaid
GA000459445AHMedicaid
GA000459445DMedicaid
GA000459445NMedicaid
GA000459445ACMedicaid
GA000459445AFMedicaid
GA000459445LMedicaid
GA000459445MMedicaid
GA000459445ABMedicaid
GA000459445CMedicaid
GA000459445ABMedicaid