Healthcare Provider Details

I. General information

NPI: 1346158516
Provider Name (Legal Business Name): ANAS ASIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 RIVERSTONE PKWY
CANTON GA
30114-2918
US

IV. Provider business mailing address

1550 RIVERSTONE PKWY
CANTON GA
30114-2918
US

V. Phone/Fax

Practice location:
  • Phone: 770-720-1023
  • Fax: 770-479-3403
Mailing address:
  • Phone: 770-720-1023
  • Fax: 770-479-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO003088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: