1437592730 NPI number — DR. MAZHAR M PASHA LPO, BOCPO, WRF

Table of content: BOBBIE JACKSON MSN, APRN, AGACNP-BC (NPI 1568055481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437592730 NPI number — DR. MAZHAR M PASHA LPO, BOCPO, WRF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASHA
Provider First Name:
MAZHAR
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LPO, BOCPO, WRF
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437592730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13606 HUGHES XING
Provider Second Line Business Mailing Address:
SUITE B.
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30228-2269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-348-6277
Provider Business Mailing Address Fax Number:
888-908-4762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13606 HUGHES XING
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30228-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-348-6277
Provider Business Practice Location Address Fax Number:
888-908-4762
Provider Enumeration Date:
04/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  99 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45-3937894 . This is a "FEDERAL ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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