Provider Demographics
NPI:1982719811
Name:DAHO-HABEEB, AMANDA ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:DAHO-HABEEB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELAINE
Other - Last Name:DAHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5001 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1308
Mailing Address - Country:US
Mailing Address - Phone:601-296-2090
Mailing Address - Fax:601-296-2089
Practice Address - Street 1:5001 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-296-2090
Practice Address - Fax:601-296-2089
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20310208M00000X, 208M00000X
MO2006020962208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207288606Medicaid
MS061320001Medicaid
MS7727820OtherAETNA
MSP00676188OtherRAILROAD MEDICARE
MS512I110272Medicare PIN
MSP00676188OtherRAILROAD MEDICARE
MS061320001Medicaid