Healthcare Provider Details

I. General information

NPI: 1497170492
Provider Name (Legal Business Name): GEZ AGOLLI ND, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N SHALLOWFORD RD
ATLANTA GA
30338-6308
US

IV. Provider business mailing address

4646 N SHALLOWFORD RD
ATLANTA GA
30338-6308
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-6000
  • Fax: 770-392-9805
Mailing address:
  • Phone: 770-676-6000
  • Fax: 770-392-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: