Healthcare Provider Details

I. General information

NPI: 1467566174
Provider Name (Legal Business Name): SAMER S KABBANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159 SUITE 125
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

1602 VERNON RD STE 300
LAGRANGE GA
30240-4129
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4570
  • Fax: 740-779-4579
Mailing address:
  • Phone: 706-242-5100
  • Fax: 706-812-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35072064
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number88103
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: