Provider Demographics
NPI:1003268889
Name:HAMOUDA, DIAA (MBBCH)
Entity type:Individual
Prefix:
First Name:DIAA
Middle Name:
Last Name:HAMOUDA
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR DR SE # 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3031
Mailing Address - Country:US
Mailing Address - Phone:404-616-4013
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:JSA 9.128
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0539
Practice Address - Country:US
Practice Address - Phone:409-772-8031
Practice Address - Fax:409-772-6940
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056520207R00000X, 2084N0400X
GA985552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine