Provider Demographics
NPI:1588284004
Name:ABUBAKAR IBRAHIM, ISMAIL (MBBS)
Entity type:Individual
Prefix:
First Name:ISMAIL
Middle Name:
Last Name:ABUBAKAR IBRAHIM
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2057
Mailing Address - Country:US
Mailing Address - Phone:229-888-3970
Mailing Address - Fax:
Practice Address - Street 1:1200 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2057
Practice Address - Country:US
Practice Address - Phone:229-888-3970
Practice Address - Fax:229-889-9386
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102497207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology