Provider Demographics
NPI:1912068768
Name:BANNOUT, FIRAS (MD)
Entity type:Individual
Prefix:
First Name:FIRAS
Middle Name:
Last Name:BANNOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4353
Mailing Address - Country:US
Mailing Address - Phone:912-877-6822
Mailing Address - Fax:912-408-6781
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4353
Practice Address - Country:US
Practice Address - Phone:912-877-6822
Practice Address - Fax:912-408-6781
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA649003064BMedicaid
GAI13036Medicare UPIN
GA511I110814Medicare PIN