Provider Demographics
NPI:1073931408
Name:ATLANTA SPINE AND ANESTHESIA
Entity Type:Organization
Organization Name:ATLANTA SPINE AND ANESTHESIA
Other - Org Name:NORTH FULTON ANESTHESIA ASSOCIATES, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./ANESTHESIOLOGIST
Authorized Official - Prefix:DR
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:770-751-2623
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1022
Mailing Address - Country:US
Mailing Address - Phone:770-751-2623
Mailing Address - Fax:770-751-2995
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD
Practice Address - Street 2:BLDG B, SUITE 225
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5909
Practice Address - Country:US
Practice Address - Phone:770-391-3979
Practice Address - Fax:770-391-0020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH FULTON ANESTHESIA ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I050496Medicare PIN