Provider Demographics
NPI:1194287763
Name:PAIN PHYSICIANS ANESTHESIA, LLC
Entity type:Organization
Organization Name:PAIN PHYSICIANS ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:SHAZAD
Authorized Official - Last Name:WADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-273-6996
Mailing Address - Street 1:3333 OLD MILTON PARKWAY, SUITE 400
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4437
Mailing Address - Country:US
Mailing Address - Phone:770-391-3979
Mailing Address - Fax:770-391-0020
Practice Address - Street 1:3333 OLD MILTON PARKWAY, SUITE 400
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4437
Practice Address - Country:US
Practice Address - Phone:770-391-3979
Practice Address - Fax:770-391-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty