Healthcare Provider Details

I. General information

NPI: 1215574280
Provider Name (Legal Business Name): AZHEEN AZIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PEACHTREE ST NE
ATLANTA GA
30308-3201
US

IV. Provider business mailing address

1111 CLAIREMONT AVE APT L3
DECATUR GA
30030-1217
US

V. Phone/Fax

Practice location:
  • Phone: 866-787-6341
  • Fax:
Mailing address:
  • Phone: 866-787-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH030097
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: