Provider Demographics
NPI:1952398406
Name:HADDAD, AYHAM Y (MD)
Entity Type:Individual
Prefix:DR
First Name:AYHAM
Middle Name:Y
Last Name:HADDAD
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 1:1250 JESSE JEWELL PKWY SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3865
Mailing Address - Country:US
Mailing Address - Phone:770-532-0800
Mailing Address - Fax:770-532-0801
Practice Address - Street 1:1250 JESSE JEWELL PKWY SE STE 300
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3865
Practice Address - Country:US
Practice Address - Phone:770-532-0800
Practice Address - Fax:770-532-0801
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA949495OtherBLUE CROSS BLUE SHIELD
GA619777309AOtherAMERIGROUP
GA619777309AMedicaid
GA355208OtherWELLCARE
GA355208OtherWELLCARE
GA619777309AOtherAMERIGROUP
GA11SCGDFMedicare PIN
GA619777309AOtherAMERIGROUP