Doctor Name: | DR. ABEBE D KASSAHUN |
NPI Number: | 1689860355 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 36117613 |
Business Practice Address: | 2100 Central Ave Suite 6 & 7 Augusta, GA - 309046717 |
Business Phone Number: | 7067365378 |
Business Fax Number: | 7067389922 |
Mailing Address: | 2100 Central Ave, Suite 6 & 7 AUGUSTA |
State: | GA |
Postal Code: | 309046717 |
Phone Number: | 7067365378 |
Fax Number: | 7067389922 |
NPI Enumeration Date: | 09/17/2007 |
NPI Last Update Date: | 10/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 36117613 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |