Provider Demographics
NPI:1801363890
Name:HAMADEH, HIBA (MMEDSCI, RDN, LD)
Entity type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:HAMADEH
Suffix:
Gender:F
Credentials:MMEDSCI, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 BRIDGEGATE DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2207
Mailing Address - Country:US
Mailing Address - Phone:813-270-6859
Mailing Address - Fax:
Practice Address - Street 1:972 BRIDGEGATE DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2207
Practice Address - Country:US
Practice Address - Phone:813-270-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered