Provider Demographics
NPI:1386879310
Name:BANGURA, ABDUL S (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:S
Last Name:BANGURA
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 1:305 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2126
Mailing Address - Country:US
Mailing Address - Phone:478-287-2228
Mailing Address - Fax:
Practice Address - Street 1:305 LATHAM DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2126
Practice Address - Country:US
Practice Address - Phone:478-287-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065932208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery