Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2021-00547 | NC |
N | 208200000X | Surgeon | 2021-00547 | NC |
N | 208600000X | Surgeon | 2021-00547 | NC |
NPI | 1427372879 |
---|---|
Provider Name | Hisham Hatoum |
First Address | Atlanta, GA 31193-6857 |
Second Address | Wilmington, NC 28403-5345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 07/07/2021 |