MEDICARE: PUSHAN PAUL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1164282265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUSHAN PAUL

Provider Business Mailing Address
First Line	:	1345 WOODLAND LAKE DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2099
Country	:	US
Telephone Number	:	404-337-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 WOODLAND LAKE DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2099
Country	:	US
Telephone Number	:	404-337-7911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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Directions to “ PUSHAN PAUL ” Practice Location

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