Provider Demographics
NPI:1902832058
Name:MAISURIA, HIMAXI M (MD)
Entity Type:Individual
Prefix:
First Name:HIMAXI
Middle Name:M
Last Name:MAISURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HIMAXI
Other - Middle Name:M
Other - Last Name:MAYSURIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:108 PALMETTO PARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7969
Practice Address - Country:US
Practice Address - Phone:803-356-0949
Practice Address - Fax:803-356-1795
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21460207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214609Medicaid
SC214609Medicaid