Benaissa Kaddour Djebbar

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN 204732 Issued in GA

Practice address

3405 Mike Padgett Hwy
East Central Regional Hospital -Forensic Unit
Augusta, GA 30906-3815

Phone

(706) 792-7073

NPI assigned

Sep 27, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1114200029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 DUNDEE WAY",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308138124",
            "telephone_number": "706-627-3762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 MIKE PADGETT HWY",
            "address_2": "EAST CENTRAL REGIONAL HOSPITAL -FORENSIC UNIT",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-792-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADDOUR DJEBBAR",
        "first_name": "BENAISSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN 204732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca L. Jump, PHD
• Mia Jung, PHARM.D.
• Britney Junior
• Alisha Risser Justice, RD, LD
• Fatin Jweinat
• Wayne Harry Kaesemeyer, MD
• Kairos: Following the Heart
• Gail Kaitschuck, MS, LD, RD
• Sajitha Menon Kalathingal, BDS, MS
• Eman Kaldas, M.D.

• Family Nurse Practitioner in Augusta, GA
• Providers in Augusta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.