Provider Demographics
NPI:1326022583
Name:MISHU, HUSHAM P (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSHAM
Middle Name:P
Last Name:MISHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE STE 610
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4212
Mailing Address - Country:US
Mailing Address - Phone:404-653-0039
Mailing Address - Fax:404-653-0159
Practice Address - Street 1:285 BOULEVARD NE STE 610
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4212
Practice Address - Country:US
Practice Address - Phone:404-653-0039
Practice Address - Fax:404-653-0159
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA407402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA40740OtherGEORGIA MEDICAL LICENSE
GABM5723021OtherGEORGIA DEA
GA1407869407OtherGROUP NPI
GA000785848CMedicaid