Individual
BENAISSA KADDOUR DJEBBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3405 MIKE PADGETT HWY, EAST CENTRAL REGIONAL HOSPITAL -FORENSIC UNIT, AUGUSTA, GA 30906-3815
(706) 792-7073
Mailing address
2060 DUNDEE WAY, GROVETOWN, GA 30813-8124
(706) 627-3762
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN 204732
GA
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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