Provider Demographics
NPI:1295780161
Name:MOLOKHIA, EHAB A (MD)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:A
Last Name:MOLOKHIA
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:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:
Practice Address - Street 1:2419 GORDON SMITH DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2318
Practice Address - Country:US
Practice Address - Phone:251-434-3475
Practice Address - Fax:251-434-3985
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272552500Medicaid
AL51512385OtherBLUE CROSS
LA1523542Medicaid
AL51512388OtherBLUE CROSS
MS00126098Medicaid
AL01-01158OtherUNITED HEALTH CARE
AL009906285Medicaid
AL51512388OtherBLUE CROSS
AL080190932Medicare ID - Type UnspecifiedRAILROAD PGBA
FL272552500Medicaid