Provider Demographics
NPI:1750586301
Name:NORTH HOUSTON MEDICAL CLINIC
Entity type:Organization
Organization Name:NORTH HOUSTON MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHI
Authorized Official - Middle Name:IBRAHEEM
Authorized Official - Last Name:SULIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-328-9901
Mailing Address - Street 1:707 N HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2101
Mailing Address - Country:US
Mailing Address - Phone:478-328-9901
Mailing Address - Fax:478-328-9390
Practice Address - Street 1:707 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2101
Practice Address - Country:US
Practice Address - Phone:478-328-9901
Practice Address - Fax:478-328-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3519Medicare ID - Type Unspecified