Individual
DR. WISSAM KHATTAR MECHLEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
21893
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02021057
—
MS
01
—
2739609
CIGNA
MS
01
—
3447986
UNITED HEALTHCARE
MS
01
—
6056932
HEALTHSPRINGS
MS
01
—
9822945
AETNA
MS
Enumeration date
10/01/2007
Last updated
07/21/2020
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