Healthcare Provider Details

I. General information

NPI: 1588319941
Provider Name (Legal Business Name): HAZEL VAZIRANI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 JOHNSON FY RD NE STE 100
ATLANTA GA
30342-1461
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5545
  • Fax:
Mailing address:
  • Phone: 866-518-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12901
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP035228T
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: