Provider Demographics
NPI:1013999291
Name:GOREISH, HISHAM H (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:H
Last Name:GOREISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 BRYNLYN WOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1426
Mailing Address - Country:US
Mailing Address - Phone:770-922-7664
Mailing Address - Fax:
Practice Address - Street 1:150 GILBREATH DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-274-3004
Practice Address - Fax:205-274-3002
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531620OtherBCBS
AL009914077Medicaid
AL051545800OtherBCBS
AL051531620Medicaid
AL051557081Medicaid
AL7903244OtherAETNA
AL051531845OtherBCBS
AL510I930122Medicare PIN
AL051545800OtherBCBS
AL051531845OtherBCBS
AL7903244OtherAETNA
AL051557081Medicare PIN
AL051531620Medicaid