Provider Demographics
NPI:1801967575
Name:KABIA, SOCCOH A (MD)
Entity type:Individual
Prefix:
First Name:SOCCOH
Middle Name:A
Last Name:KABIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-7138
Mailing Address - Country:US
Mailing Address - Phone:770-577-4825
Mailing Address - Fax:770-577-4827
Practice Address - Street 1:8954 HOSPITAL DR
Practice Address - Street 2:SUITE C115
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2272
Practice Address - Country:US
Practice Address - Phone:770-577-4825
Practice Address - Fax:770-577-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043978207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDTJBMedicare ID - Type Unspecified
GAG54988Medicare UPIN