Provider Demographics
NPI:1144285073
Name:ABELL, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:ABELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72105
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2105
Mailing Address - Country:US
Mailing Address - Phone:229-438-5864
Mailing Address - Fax:229-438-1004
Practice Address - Street 1:804 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-438-5864
Practice Address - Fax:229-438-1004
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00046639FMedicaid
GA000466639EMedicaid
GAE87766Medicare UPIN
GA11SCFZRMedicare ID - Type UnspecifiedCAHABA MEDICARE PROV