Provider Demographics
NPI:1417274572
Name:ATIYA WAHEED MD PA
Entity Type:Organization
Organization Name:ATIYA WAHEED MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATIYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-536-9700
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
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
Practice Address - Country:US
Practice Address - Phone:870-536-9700
Practice Address - Fax:870-536-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty