Healthcare Provider Details

I. General information

NPI: 1962481168
Provider Name (Legal Business Name): MOHAMMAD ANNABA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 HIGHWAY 515 S
JASPER GA
30143-4872
US

IV. Provider business mailing address

945 BETHESDA DRIVE SUITE 200
ZANESVILLE OH
43701-1880
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone: 740-454-4788
  • Fax: 740-450-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number90142
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: