Healthcare Provider Details

I. General information

NPI: 1720243207
Provider Name (Legal Business Name): FARIDA ZOHOURI ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FARIDA ZOHOURI

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 MARTIN LUTHER KING JR. DR. SW
ATLANTA GA
30311
US

IV. Provider business mailing address

2536 MARTIN LUTHER KING JR. DR.SW
ATLANTA GA
30311
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-7774
  • Fax: 404-699-7716
Mailing address:
  • Phone: 404-699-7774
  • Fax: 404-699-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNT9001042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: