Basic Information
| Provider Information | |||||||||
| NPI: | 1376541078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KABBANI | ||||||||
| FirstName: | AZMI | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 640 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312013206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455455 | ||||||||
| FaxNumber: | 4787452915 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312013206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455455 | ||||||||
| FaxNumber: | 4787452915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 31171 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 000459445AE | 05 | GA | MEDICAID | 000459445AJ | 05 | GA | MEDICAID | 000459445AK | 05 | GA | MEDICAID | 000459445AL | 05 | GA | MEDICAID | 110063832 | 01 | RAILROAD MEDICARE | OTHER | 000459445AI | 05 | GA | MEDICAID | 000459445C | 05 | GA | MEDICAID | 000459445AD | 05 | GA | MEDICAID | 000459445B | 05 | GA | MEDICAID | 000459445P | 05 | GA | MEDICAID | 028816 | 01 | BLUE CROSS | OTHER | 000459445Z | 05 | GA | MEDICAID | 000459445AG | 05 | GA | MEDICAID | 000459445AH | 05 | GA | MEDICAID | 000459445D | 05 | GA | MEDICAID | 000459445N | 05 | GA | MEDICAID | 000459445AC | 05 | GA | MEDICAID | 000459445AF | 05 | GA | MEDICAID | 000459445L | 05 | GA | MEDICAID | 000459445M | 05 | GA | MEDICAID | 000459445AB | 05 | GA | MEDICAID |