Provider Demographics
NPI:1629410113
Name:ATHAR, ASIMA Q (PA)
Entity Type:Individual
Prefix:MS
First Name:ASIMA
Middle Name:Q
Last Name:ATHAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4460
Mailing Address - Country:US
Mailing Address - Phone:336-789-7555
Mailing Address - Fax:336-789-8270
Practice Address - Street 1:826 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4460
Practice Address - Country:US
Practice Address - Phone:336-789-7555
Practice Address - Fax:336-789-8270
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100921363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical