Provider Demographics
NPI:1114347580
Name:PAU, TIK (MD)
Entity Type:Individual
Prefix:
First Name:TIK
Middle Name:
Last Name:PAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 DULUTH HWY STE 501
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8709
Mailing Address - Country:US
Mailing Address - Phone:678-312-0400
Mailing Address - Fax:678-312-0423
Practice Address - Street 1:665 DULUTH HWY STE 501
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8709
Practice Address - Country:US
Practice Address - Phone:678-312-0400
Practice Address - Fax:678-312-0423
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine