Healthcare Provider Details

I. General information

NPI: 1215434055
Provider Name (Legal Business Name): ABDELRAHIM YAMIN ABDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 WHEELER RD STE B
AUGUSTA GA
30909-6756
US

IV. Provider business mailing address

5900 BALCONES DR STE 21931
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3645
  • Fax:
Mailing address:
  • Phone: 347-561-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberU2758
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD.48643
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101282404
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number98991
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number34211
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberU2758
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: