Healthcare Provider Details

I. General information

NPI: 1356227797
Provider Name (Legal Business Name): MRS. ANAHITA REZAEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MOUNT VERNON RD STE 100
ATLANTA GA
30338-4259
US

IV. Provider business mailing address

3378 COBB PKWY NW
ACWORTH GA
30101-8358
US

V. Phone/Fax

Practice location:
  • Phone: 770-671-2797
  • Fax:
Mailing address:
  • Phone: 678-202-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH034599
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: