Provider Demographics
NPI:1447404447
Name:PAU, DERRICK C (MD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:C
Last Name:PAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:
Practice Address - Street 1:3225 CUMBERLAND BLVD SE
Practice Address - Street 2:SUITE 900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6407
Practice Address - Country:US
Practice Address - Phone:404-351-2220
Practice Address - Fax:404-352-5392
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA076620207WX0009X, 207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I189735OtherMEDICARE PTAN
GA00312691BMedicaid