Provider Demographics
NPI:1962518969
Name:LABIB, SAMEH AKHNOUKH (MD)
Entity type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:AKHNOUKH
Last Name:LABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:468 TARA TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4926
Mailing Address - Country:US
Mailing Address - Phone:404-862-7287
Mailing Address - Fax:
Practice Address - Street 1:EMORY SPORTS MEDICINE CENTER
Practice Address - Street 2:1968 HAWKS LANE #200
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2283
Practice Address - Country:US
Practice Address - Phone:404-778-4398
Practice Address - Fax:404-778-7071
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47338207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00833874AMedicaid
GAF43894Medicare UPIN
GA20BBDSWMedicare ID - Type Unspecified