Individual
SHARIF FIESAL ELKABBANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1230 BAXTER ST, ATHENS, GA 30606
(706) 389-3410
(706) 389-3411
Mailing address
PO BOX 7695, ATHENS, GA 30604-7695
(706) 389-3410
(706) 389-3411
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
059912
GA
207R00000X
Internal Medicine Physician
35.089439
OH
208M00000X
Hospitalist Physician
Primary
059912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10066938
AMERIGROUP
GA
01
—
2836617
UHC
GA
01
—
405271
WELLCARE
GA
01
—
5147641
CIGNA
GA
01
—
52206175
BCBS
GA
01
—
889267212A
PEACH STATE
GA
05
—
889267212A
—
GA
05
—
889267212B
—
GA
05
—
889267212G
—
GA
01
—
9319080
AETNA
GA
01
—
P00465763
MEDICARE RAILROAD CARRIER, PALMETTO GBA
GA
Enumeration date
03/26/2007
Last updated
08/17/2021
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