=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437592730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAZHAR M PASHA LPO, BOCPO, WRF
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2013
-----------------------------------------------------
Last Update Date | 11/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13606 HUGHES XING SUITE B
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30228-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-348-6277
-----------------------------------------------------
Fax | 888-908-4762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13606 HUGHES XING SUITE B.
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30228-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-348-6277
-----------------------------------------------------
Fax | 888-908-4762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 99
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------