Healthcare Provider Details

I. General information

NPI: 1972588416
Provider Name (Legal Business Name): NABIL LUTFI MUHANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 02/09/2023
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3854
US

IV. Provider business mailing address

2128 VALLEY RD NE
GAINESVILLE GA
30501-1237
US

V. Phone/Fax

Practice location:
  • Phone: 770-533-7288
  • Fax: 770-534-9800
Mailing address:
  • Phone: 678-206-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number023643
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number023643
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: