Provider Demographics
NPI:1780252932
Name:HUSSEIN, NIMO (MD)
Entity type:Individual
Prefix:
First Name:NIMO
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HEMLOCK ST STE 220
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8311
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:478-745-8932
Practice Address - Street 1:657 HEMLOCK ST STE 220
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8311
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:478-745-8932
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA101120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program