Healthcare Provider Details

I. General information

NPI: 1194287763
Provider Name (Legal Business Name): PAIN PHYSICIANS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 OLD MILTON PARKWAY, SUITE 400
ALPHARETTA GA
30005-4437
US

IV. Provider business mailing address

3333 OLD MILTON PARKWAY, SUITE 400
ALPHARETTA GA
30005-4437
US

V. Phone/Fax

Practice location:
  • Phone: 770-391-3979
  • Fax: 770-391-0020
Mailing address:
  • Phone: 770-391-3979
  • Fax: 770-391-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMED SHAZAD WADA
Title or Position: MEMBER
Credential: M.D.
Phone: 404-273-6996