Provider Demographics
NPI:1326097197
Name:WAHEED, ATIYA N (MD)
Entity Type:Individual
Prefix:
First Name:ATIYA
Middle Name:N
Last Name:WAHEED
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 1:1608 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7006
Mailing Address - Country:US
Mailing Address - Phone:870-536-9700
Mailing Address - Fax:870-536-7706
Practice Address - Street 1:1608 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7006
Practice Address - Country:US
Practice Address - Phone:870-536-9700
Practice Address - Fax:870-536-7706
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103008001Medicaid
11574000000OtherQUALCHOICE
828013220OtherRAILROAD MEDICARE
AR103008001Medicaid
828013220OtherRAILROAD MEDICARE