Provider Demographics
NPI:1528381522
Name:PUNJA, PUNAM JAVIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PUNAM
Middle Name:JAVIA
Last Name:PUNJA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PUNAM
Other - Middle Name:
Other - Last Name:JAVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:STE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1720
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-253-6824
Practice Address - Fax:404-253-6825
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0010-04357363AM0700X
GA5792363AM0700X
GA005792363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical