Provider Demographics
NPI:1821348350
Name:BADARUDDIN, SYED S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SYED
Middle Name:S
Last Name:BADARUDDIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-979-3989
Mailing Address - Fax:770-979-4330
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 160
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-979-3989
Practice Address - Fax:770-979-4330
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA823363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical