Provider Demographics
NPI:1174561138
Name:WITTER HEWITT, MALAIKA MANJU (MD)
Entity type:Individual
Prefix:DR
First Name:MALAIKA
Middle Name:MANJU
Last Name:WITTER HEWITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MALAIKA
Other - Middle Name:M
Other - Last Name:MANJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-297-1780
Mailing Address - Fax:404-252-7255
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-297-1780
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057267207Y00000X, 207YS0012X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA343624855BMedicaid
GA343624855UMedicaid
GA52173053OtherBCBS OF GEORGIA
GA343624855AMedicaid
GA343624855TMedicaid
GA343624855CMedicaid
GA343624855YMedicaid
GA202I043911Medicare PIN
GA343624855AMedicaid