Basic Information
| Provider Information | |||||||||
| NPI: | 1164983748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABONOFAL | ||||||||
| FirstName: | ABDULRAHMAN | ||||||||
| MiddleName: | HASSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70622 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376141709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 SHERIDAN SQ STE 200 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376607435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232467931 | ||||||||
| FaxNumber: | 4232461906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.