=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598795833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHAMMED HUMAYUN KABIR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 486 S FLORENCE AVE
-----------------------------------------------------
City | JELLICO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37762-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-784-1197
-----------------------------------------------------
Fax | 423-784-1123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 486 S FLORENCE AVE
-----------------------------------------------------
City | JELLICO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37762-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-784-1197
-----------------------------------------------------
Fax | 423-784-1123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | MD0000026093
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | MD0000026093
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD0000026093
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 43944
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------