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General NPI Number Information
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NPI Number | 1801164389
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Entity Type | Individual
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Provider Name | MIR ABDUL WADUD NP
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 1758 COUNTY SERVICES PKWY SW
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City | MARIETTA
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State | GA
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Zip | 30008-4012
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Country | US
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Telephone | 404-794-4857
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Fax |
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Provider Business Mailing Address
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Address Line | 4031 WILLOWMERE TRCE NW
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City | KENNESAW
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State | GA
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Zip | 30144-6182
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Country | US
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Telephone | 678-446-1473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 210808
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN250110
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License Number State | NC
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