Organization
KUKASWADIA P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD A KUKASWADIA MD (PHYSICIAN)
(678) 501-5420
Entity
Organization
Contact information
Practice address
4904 TIMBER RIDGE DR, SUITE 305, DOUGLASVILLE, GA 30135-1828
(678) 501-5420
Mailing address
822 RIVERTON PARK PL SE, MABLETON, GA 30126-5685
(678) 501-5420
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
43997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000757985L
—
GA
Enumeration date
07/15/2010
Last updated
01/18/2012
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