Healthcare Provider Details

I. General information

NPI: 1629286307
Provider Name (Legal Business Name): PAWANJIT SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 WIMBERLY RD NE
BROOKHAVEN GA
30319-2636
US

IV. Provider business mailing address

1105 WIMBERLY RD NE
ATLANTA GA
30319-2636
US

V. Phone/Fax

Practice location:
  • Phone: 404-368-7307
  • Fax:
Mailing address:
  • Phone: 404-368-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number058930
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number058930
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: