Provider Demographics
NPI:1811421415
Name:ABDEL JALIL, SALAH DIAB (MD)
Entity type:Individual
Prefix:MR
First Name:SALAH
Middle Name:DIAB
Last Name:ABDEL JALIL
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 1:800 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8308
Mailing Address - Country:US
Mailing Address - Phone:478-633-6900
Mailing Address - Fax:478-633-2175
Practice Address - Street 1:800 1ST ST STE 240
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8308
Practice Address - Country:US
Practice Address - Phone:478-633-6900
Practice Address - Fax:478-633-2175
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA101190208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program