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General NPI Number Information
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NPI Number | 1194287763
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Entity Type | Organization
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Legal Business Name | PAIN PHYSICIANS ANESTHESIA, LLC
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 3333 OLD MILTON PARKWAY, SUITE 400
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City | ALPHARETTA
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State | GA
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Zip | 30005-4437
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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 | 3333 OLD MILTON PARKWAY, SUITE 400
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City | ALPHARETTA
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State | GA
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Zip | 30005-4437
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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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Authorized Official
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Title or Position | MEMBER
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Name | MR. MOHAMMED SHAZAD WADA
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Credential | M.D.
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Telephone | 404-273-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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