Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 055062 | GA |
NPI | 1861448110 |
---|---|
Provider Name | Mokhtar Hacena |
First Address | Warner Robins, GA 31093-3634 |
Second Address | Warner Robins, GA 31093-3634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257348755B | (05) | GA |
H71865 | (02) | |
P00332224 | MEDICARE RAILROAD# (01) | GA |