Provider Demographics
NPI:1306809686
Name:HABBEB-ULLAH, QUANZETTA B (NP)
Entity type:Individual
Prefix:
First Name:QUANZETTA
Middle Name:B
Last Name:HABBEB-ULLAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3901
Mailing Address - Country:US
Mailing Address - Phone:912-356-2157
Mailing Address - Fax:912-691-6807
Practice Address - Street 1:2011 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3905
Practice Address - Country:US
Practice Address - Phone:912-356-2157
Practice Address - Fax:912-691-6807
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076884363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000816219BMedicaid
GA50BBCSLMedicare ID - Type UnspecifiedNP