Basic Information
| Provider Information | |||||||||
| NPI: | 1487941597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAEB | ||||||||
| FirstName: | ABDALSAMIH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1664 MULKEY RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704221372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1664 MULKEY RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704221372 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2011 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD452290 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 0116029789 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 0116029789 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 208M00000X | MD452290 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RP1001X | 84225 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 102987999 | 05 | PA | MEDICAID |