Healthcare Provider Details

I. General information

NPI: 1093067084
Provider Name (Legal Business Name): KAMBIZ AFLATOON DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD SUITE A
ATLANTA GA
30338-6520
US

IV. Provider business mailing address

2150 PEACHFORD HOSPITAL SUITE A
ATLLANTA GA
30338-6521
US

V. Phone/Fax

Practice location:
  • Phone: 770-674-0554
  • Fax:
Mailing address:
  • Phone: 770-674-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number66238
License Number StateGA

VIII. Authorized Official

Name: DR. KAMBIZ AFLATOON
Title or Position: CEO
Credential: DO
Phone: 248-535-8363