Provider Demographics
NPI:1457348310
Name:NWADEI, FABIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:
Last Name:NWADEI
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 1:525 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2204
Mailing Address - Country:US
Mailing Address - Phone:229-446-3773
Mailing Address - Fax:229-446-3776
Practice Address - Street 1:525 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2204
Practice Address - Country:US
Practice Address - Phone:229-446-3773
Practice Address - Fax:229-446-3776
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00742882FMedicaid
GA00742882FMedicaid
11BDSVJMedicare ID - Type Unspecified