Individual
DR. ABIEDU CHARLES ABAABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 PRUDENTIAL DR STE 515, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32207-8207
(904) 396-4886
(904) 398-0496
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME99772
FL
207RI0200X
Infectious Disease Physician
Primary
ME99772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001381300
—
FL
01
—
P00787517
RR MEDICARE
FL
Enumeration date
06/15/2007
Last updated
11/19/2024
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