Provider Demographics
NPI:1043044357
Name:ABUELAZM, ADEL ABDEDHAMID SR
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:ABDEDHAMID
Last Name:ABUELAZM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADEL
Other - Middle Name:AZM
Other - Last Name:DAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1326 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-691-3600
Mailing Address - Fax:
Practice Address - Street 1:1326 EISENHOWER DR BLDG 1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-691-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT004236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist