MEDICARE: WISSAM A JABER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	66954	GA
2	207RC0000X	Cardiovascular Disease Physician	66954	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421417307P4	OTHER	IA	UHC/RIVER VALLEY/JD PREMIER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053390427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WISSAM A JABER M.D.

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	MOT 6TH FLOOR CARDIOLOGY
City	:	ATLANTA
State	:	GA
Zip	:	30308-2208
Country	:	US
Telephone Number	:	404-686-1474
Fax Number	:	404-686-4445

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	MOT 6TH FLOOR CARDIOLOGY
City	:	ATLANTA
State	:	GA
Zip	:	30308-2208
Country	:	US
Telephone Number	:	404-686-1474
Fax Number	:	404-686-4445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/20/2015

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Directions to “ WISSAM A JABER M.D.” Practice Location

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