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General NPI Number Information
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NPI Number | 1417274572
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Entity Type | Organization
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Legal Business Name | ATIYA WAHEED MD PA
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 1608 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603
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Country | US
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Telephone | 870-536-9700
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Fax | 870-536-7706
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Provider Business Mailing Address
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Address Line | 1608 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603
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Country | US
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Telephone | 870-536-9700
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Fax | 870-536-7706
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Authorized Official
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Title or Position | OWNER
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Name | ATIYA N WAHEED
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Credential | MD
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Telephone | 870-536-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R2853
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License Number State | AR
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