Provider Demographics
NPI:1174118186
Name:BUDHWANI, ESHAN (PA-C)
Entity type:Individual
Prefix:
First Name:ESHAN
Middle Name:
Last Name:BUDHWANI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 PRESERVE PASS
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4279
Mailing Address - Country:US
Mailing Address - Phone:678-628-3942
Mailing Address - Fax:
Practice Address - Street 1:371 NEWNAN CROSSING BYP STE 103
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3888
Practice Address - Country:US
Practice Address - Phone:770-400-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant