BENAISSA KADDOUR DJEBBAR (NPI# 1114200029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114200029 |
| Entity Type | Individual |
| Full Name | BENAISSA KADDOUR DJEBBAR |
| Practice Address |
3405 Mike Padgett Hwy East Central Regional Hospital -forensic Unit Augusta GA 30906-3815 |
| Mailing Address |
2060 Dundee Way Grovetown GA 30813-8124 |
| Practice Telephone | 7067927073 |
| Mailing Telephone | 7066273762 |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-09-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APRN 204732 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3405 MIKE PADGETT HWY EAST CENTRAL REGIONAL HOSPITAL -FORENSIC UNIT |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30906-3815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548288632 | Mona H Hanna | Psychiatry & Neurology | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2006-07-17 |
| 1912521394 | Cassandra Groth | Psychologist | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2020-06-02 |
| 1619536737 | David Armando Vivas Villarreal | Psychiatry & Neurology | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2019-06-12 |
| 1699261487 | Latasha R Ford | Nurse Practitioner | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2018-07-05 |
| 1548781453 | Tracy Casanova | Psychologist | 3405 Mike Padgett Hwy, Augusta, GA 30906 | 2017-06-30 |
| 1811448806 | Christina M Daniels | Nurse Practitioner | 3405 Mike Padgett Hwy, Augusta, GA 30906 | 2016-10-14 |
| 1528489523 | Laurie Ragatz | Psychologist | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2013-12-18 |
| 1396176145 | Linda Vitacco | Psychologist | 3405 Mike Padgett Hwy, Attention Patient Accounts, Augusta, GA 30906-3815 | 2013-12-04 |
| 1669809455 | Lynne Anne Daurelle | Psychologist | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2013-10-11 |
| 1255681243 | Maria Bratoeva | Nurse Practitioner | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2012-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969432 | Barton Chapel Dental Group, LLC | Dentist | 2755 Barton Chapel Road, Augusta, GA 30906 | 2020-04-01 |
| 1255897419 | Pediatric Mobility Innovations | Durable Medical Equipment & Medical Supplies | 3114 Augusta Tech Drive Suite 404, Augusta, GA 30906 | 2019-02-13 |
| 1023539731 | Kristy Lee Gibbs | Registered Nurse | 3421 Mike Padgett Hwy Bldg C, Augusta, GA 30906 | 2017-07-03 |
| 1194186031 | Clifton Nane Williams | Counselor | 3230 Hampton Circle, Augusta, GA 30906 | 2016-03-18 |
| 1376929661 | Catherine A. Ganzy | Social Worker | 3405 Mike Padgett Highway; Building 201, East Central Regional Hosptial, Augusta, GA 30906 | 2015-08-10 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1568809770 | Brandon Jennings | Occupational Therapy Assistant | 2388 Old Mcduffie Rd, Augusta, GA 30906 | 2013-05-29 |
| 1811266646 | Eddie P Johnson IIi, Dmd, PC | Preferred Provider Organization | 2755 Barton Chapel Rd, Augusta, GA 30906 | 2011-12-23 |
| 1366739021 | Kerensa A Cooks | Registered Nurse | 3421 Mike Padgett Highway, Serenity Behavioral Health Systems, Augusta, GA 30906 | 2011-07-01 |
| 1265737423 | Pidcock Chiropractic, Inc. | Chiropractor | 3028 Peach Orchard Rd., Augusta, GA 30906 | 2011-01-20 |
| Find all providers in zip 30906 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962894 | Anna Marie Kodama | Nurse Practitioner | 462 Furys Ferry Rd # C, Augusta, GA 30907-9506 | 2020-11-03 |
| 1588262372 | Taylor Safford | Nurse Practitioner | 1348 Walton Way Ste 4100, Augusta, GA 30901-5107 | 2020-10-13 |
| 1831719269 | Tanaysa Green | Nurse Practitioner | 1702 Holly Hill Rd, Augusta, GA 30904-5050 | 2020-04-27 |
| 1699395749 | Mary Elizabeth Dalis | Nurse Practitioner | 1025 Redbird Rd, Augusta, GA 30904-3181 | 2020-04-18 |
| 1316585185 | Rebecca Williford | Nurse Practitioner | 1220 George C Wilson Dr, Augusta, GA 30909-4501 | 2019-12-12 |
| 1699322370 | Ashley Staten | Nurse Practitioner | 2739 Huntcliffe Dr, Augusta, GA 30909-0662 | 2019-08-19 |
| 1053978205 | Keneka V Allen | Nurse Practitioner | 6229 Key West Dr, Augusta, GA 30909-6745 | 2019-05-23 |
| 1487210589 | Jason Schunk | Nurse Practitioner | S7645 Morning Crest Dr, Augusta, WI 54722-7579 | 2019-05-14 |
| 1740754308 | Patricia Lynn Blevins | Nurse Practitioner | 300 E Hospital Dr, Augusta, GA 30905 | 2019-01-17 |
| 1174097190 | Yuri Kang | Nurse Practitioner | Augusta University Medical Center 1120 15th Street, Augusta, GA 30912-0359 | 2019-01-12 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.