Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301112630 | MI |
NPI | 1083134555 |
---|---|
Provider Name | Enas Abdallah |
First Address | Atlanta, GA 30384-8441 |
Second Address | Tampa, FL 33612-9416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 02/09/2021 |