Provider Demographics
NPI:1992718100
Name:QADIR, ABDUL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:QADIR
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 1:1101 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5537
Mailing Address - Country:US
Mailing Address - Phone:478-923-3535
Mailing Address - Fax:478-923-3573
Practice Address - Street 1:1101 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5537
Practice Address - Country:US
Practice Address - Phone:478-923-3535
Practice Address - Fax:478-923-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0413522084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884639BMedicaid
GA000884639BMedicaid
GA000884639BMedicaid