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General NPI Number Information
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NPI Number | 1154322923
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Entity Type | Individual
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Provider Name | JIBRAN ELIAS ATWI MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 401 YOUNGSVILLE HWY SUITE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-5173
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Country | US
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Telephone | 337-330-0031
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Fax | 337-330-0059
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Provider Business Mailing Address
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Address Line | 2308 E MAIN ST SUITE G
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City | NEW IBERIA
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State | LA
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Zip | 70560-4041
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Country | US
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Telephone | 337-367-2001
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Fax | 337-365-3050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10447R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 10447R
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License Number State | LA
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