Basic Information
| Provider Information | |||||||||
| NPI: | 1154685550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELFASI | ||||||||
| FirstName: | ABDULJALIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 KENT RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317941697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293914310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 39 KENT RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317941697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293914310 | ||||||||
| FaxNumber: | 2293914243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 76709 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.