Provider Demographics
NPI:1063616621
Name:GEORGE-ABRAHAM, JAYA KANNIAKONIL (MD)
Entity type:Individual
Prefix:DR
First Name:JAYA
Middle Name:KANNIAKONIL
Last Name:GEORGE-ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 AUSTIN CENTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3157
Mailing Address - Country:US
Mailing Address - Phone:512-628-1840
Mailing Address - Fax:512-628-1841
Practice Address - Street 1:6811 AUSTIN CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3157
Practice Address - Country:US
Practice Address - Phone:512-628-1840
Practice Address - Fax:512-628-1841
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3665207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288021301Medicaid
TX288021301Medicaid