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General NPI Number Information
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NPI Number | 1073931408
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Entity Type | Organization
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Legal Business Name | ATLANTA SPINE AND ANESTHESIA
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 6105 PEACHTREE DUNWOODY RD BLDG B, SUITE 225
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City | ATLANTA
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State | GA
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Zip | 30328-5909
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Country | US
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Telephone | 770-391-3979
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Fax | 770-391-0020
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Provider Business Mailing Address
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Address Line | PO BOX 1022
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City | ALPHARETTA
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State | GA
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Zip | 30009-1022
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Country | US
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Telephone | 770-751-2623
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Fax | 770-751-2995
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Authorized Official
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Title or Position | M.D./ANESTHESIOLOGIST
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Name | DR. MOHAMMED SHAZAD WADA
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Credential | M.D.
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Telephone | 770-751-2623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 063043
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License Number State | GA
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