Healthcare Provider Details

I. General information

NPI: 1114727765
Provider Name (Legal Business Name): CPN NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 FLORENCE RD STE 200
POWDER SPRINGS GA
30127-3806
US

IV. Provider business mailing address

3380 FLORENCE RD STE 200
POWDER SPRINGS GA
30127-3806
US

V. Phone/Fax

Practice location:
  • Phone: 909-720-4018
  • Fax:
Mailing address:
  • Phone: 909-720-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAM AWAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-720-4018