Provider Demographics
NPI:1538233531
Name:ABDELHAI, ELTIGANI M (MD)
Entity type:Individual
Prefix:
First Name:ELTIGANI
Middle Name:M
Last Name:ABDELHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-533-6645
Practice Address - Fax:770-535-2642
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043077207R00000X
GA061685208M00000X
CODR.0067148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA662789161BMedicaid
GAP11806575OtherMEDICARE RAILROAD
GA110029C0551229OtherTRAILBLAZERS
GA2945742OtherCIGNA
GA459788OtherWELLCARE
GA662789161AMedicaid
GA662789161CMedicaid
GA662789161FMedicaid
GA7740605OtherAETNA
GA01237654OtherAMERIGROUP
GA52253417OtherBCBS
GA459788OtherWELLCARE
GAP11806575OtherMEDICARE RAILROAD