Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 060648 | GA |
NPI | 1164692174 |
---|---|
Provider Name | Usama B Kanaan |
First Address | Atlanta, GA 30341-5540 |
Second Address | Atlanta, GA 30329-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367158412H | (05) | GA |