DR. WISSAM KHATTAR MECHLEB (NPI# 1487841847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487841847 |
| Entity Type | Individual |
| Full Name | DR. WISSAM KHATTAR MECHLEB |
| Credential | MD |
| Practice Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012685800 |
| Practice Fax Number | 6012613530 |
| Mailing Telephone | 6012685800 |
| Mailing Fax Number | 6015795240 |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2020-07-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
21893 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | CIGNA | 2739609 | 01 |
| MS | AETNA | 9822945 | 01 |
| MS | HEALTHSPRINGS | 6056932 | 01 |
| MS | 02021057 | 05 | |
| MS | UNITED HEALTHCARE | 3447986 | 01 |
| Street Address |
415 S 28TH AVE |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-7246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225030372 | Norman Blake Moore Jr. | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2005-06-01 |
| 1457950842 | Tyler Griffin Armstrong | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-10-19 |
| 1538776679 | Hattiesburg Clinic, Pa | Clinic/Center | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-09-23 |
| 1205446804 | Robert Price Ledbetter | Perfusionist | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-08-07 |
| 1972143626 | Jarrod Edward Gant | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2020-01-10 |
| 1720625841 | Corey Lyle Gambrell | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-12-09 |
| 1447802103 | Heather Pritchett Bassi | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-12 |
| 1891357588 | Dylan Winston Boyd | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-02 |
| 1578124186 | Casie Barnes | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-06-25 |
| 1992364491 | Stacy Louise Neames | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2019-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770528713 | John R Lovejoy | Internal Medicine | 6813 Hwy 98 West, Hattiesburg, MS 39402 | 2006-06-16 |
| 1184665580 | Fisher Alan Covin | Internal Medicine | 5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331 | 2006-06-09 |
| 1558593764 | Heartcare of Southern Mississippi | Internal Medicine | 200 Hospital Dr W, Hattiesburg, MS 39402-1346 | 2009-08-20 |
| 1295931145 | Viral Lathia | Internal Medicine | 5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331 | 2007-06-26 |
| 1568545176 | Benjamin T Rester | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-10-24 |
| 1568559813 | Hattiesburg Clinic Pa | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-10-06 |
| 1952409609 | Craig Andrew Thieling | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-09-20 |
| 1588773774 | Thad F Waites | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-30 |
| 1598875304 | Robert G Wilkins | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-30 |
| 1639288293 | Randel L Smith | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-29 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
Please comment or provide details below to improve the information on DR. WISSAM KHATTAR MECHLEB.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.