Healthcare Provider Details

I. General information

NPI: 1649822768
Provider Name (Legal Business Name): MOHAB WAEL NOMAN HASSIB MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

4811 LA PIEDRA LN
LEAGUE CITY TX
77573-7113
US

V. Phone/Fax

Practice location:
  • Phone: 229-433-1000
  • Fax:
Mailing address:
  • Phone: 609-826-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29N00000X
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number103858
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: