Provider Demographics
NPI:1497787998
Name:HISAMUDDIN, SEEMA M (MD)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:M
Last Name:HISAMUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 DALLAS HWY SW
Mailing Address - Street 2:SUITE 340
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2597
Mailing Address - Country:US
Mailing Address - Phone:678-797-9800
Mailing Address - Fax:678-797-9801
Practice Address - Street 1:2655 DALLAS HWY SW
Practice Address - Street 2:SUITE 340
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2597
Practice Address - Country:US
Practice Address - Phone:678-797-9800
Practice Address - Fax:678-797-9801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA200000006DMedicaid
GA200000006CMedicaid
GA200000006CMedicaid
GA11SCGKDMedicare ID - Type Unspecified
BH9794163OtherDEA
GA200000006CMedicaid