Provider Demographics
NPI:1841257136
Name:PAHL, DOUGLAS WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WESLEY
Last Name:PAHL
Suffix:
Gender:M
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:6262 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3540
Practice Address - Country:US
Practice Address - Phone:706-494-3192
Practice Address - Fax:706-494-3247
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28824207X00000X
GA049468207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA361784635DMedicaid
GA361784635HMedicaid
GA361784635GMedicaid
GA361784635BMedicaid
GA361784635FMedicaid
GA361784635AMedicaid
GA361784635CMedicaid
GA361784635EMedicaid
GA361784635EMedicaid
GA361784635HMedicaid