Provider Demographics
NPI:1679213045
Name:HMISSA, WALID (DO)
Entity Type:Individual
Prefix:DR
First Name:WALID
Middle Name:
Last Name:HMISSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 E PARK AVE APT X12
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5346
Mailing Address - Country:US
Mailing Address - Phone:941-730-2896
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3332
Practice Address - Country:US
Practice Address - Phone:678-312-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program