Individual
FIRAS BANNOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
455 S MAIN ST, STE 201, HINESVILLE, GA 31313-4353
(912) 877-6822
(912) 408-6781
Mailing address
455 S MAIN ST, STE 201, HINESVILLE, GA 31313-4353
(912) 877-6822
(912) 408-6781
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
055176
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
649003064B
—
GA
Enumeration date
12/13/2006
Last updated
12/04/2009
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