Provider Demographics
NPI:1548504319
Name:ABBINGH LLC
Entity type:Organization
Organization Name:ABBINGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-929-0634
Mailing Address - Street 1:1368 WELLBROOK CIR NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3949
Mailing Address - Country:US
Mailing Address - Phone:770-929-0634
Mailing Address - Fax:770-929-8716
Practice Address - Street 1:1368 WELLBROOK CIR NE
Practice Address - Street 2:SUITE B
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3949
Practice Address - Country:US
Practice Address - Phone:770-929-0634
Practice Address - Fax:770-929-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60695174400000X
GA60991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA314646331BMedicaid
GA417660047BMedicaid
GA202I023001Medicare PIN
GA417660047BMedicaid