Provider Demographics
NPI:1669406757
Name:ISSA, MUTA M (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:MUTA
Middle Name:M
Last Name:ISSA
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 CLAIRMONTH ROAD, NE
Mailing Address - Street 2:AVAMC / UROLOGY (112)
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-728-4129
Mailing Address - Fax:404-329-2201
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:AVAMC / UROLOGY (112)
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-728-4129
Practice Address - Fax:404-329-2201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42619208800000X
GA042619208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology