Individual
DR. ERIC AKONWI MABO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 219-2627
(770) 219-7365
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
(770) 219-8440
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
055263
GA
207R00000X
Internal Medicine Physician
055263
GA
207R00000X
Internal Medicine Physician
25MA09022900
NJ
208M00000X
Hospitalist Physician
055263
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000628600
—
FL
05
—
560938790B
—
GA
01
—
P00712052
RR MEDICARE
FL
Enumeration date
07/21/2005
Last updated
08/15/2019
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