Provider Demographics
NPI:1942016126
Name:ABDULJALIL, UMM HABIBAH SADAQA
Entity type:Individual
Prefix:
First Name:UMM HABIBAH
Middle Name:SADAQA
Last Name:ABDULJALIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 PENNEFEATHER LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4714
Mailing Address - Country:US
Mailing Address - Phone:404-707-6442
Mailing Address - Fax:
Practice Address - Street 1:1165 PENNEFEATHER LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4714
Practice Address - Country:US
Practice Address - Phone:404-707-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053176244172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver