Healthcare Provider Details

I. General information

NPI: 1033737432
Provider Name (Legal Business Name): SUBAHANA ABOOBUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

PO BOX 11407 DEPT 2130
BIRMINGHAM AL
35246-2130
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-2005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number37307
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: