Healthcare Provider Details

I. General information

NPI: 1043697022
Provider Name (Legal Business Name): MOHAMMED AL GADBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 POWDERSVILLE RD STE B
EASLEY SC
29642-2417
US

IV. Provider business mailing address

1026 POWDERSVILLE RD STE B
EASLEY SC
29642-2417
US

V. Phone/Fax

Practice location:
  • Phone: 864-883-9737
  • Fax: 864-883-9738
Mailing address:
  • Phone: 864-883-9737
  • Fax: 864-883-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD38034
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: