Healthcare Provider Details

I. General information

NPI: 1629599980
Provider Name (Legal Business Name): CLAUDIA ZYSKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 DEP BILL CANTRELL MEMORIAL RD STE 300
CUMMING GA
30040-3007
US

IV. Provider business mailing address

4150 DEP BILL CANTRELL MEMORIAL RD STE 300
CUMMING GA
30040-3007
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-8111
  • Fax: 770-205-8539
Mailing address:
  • Phone: 770-886-8111
  • Fax: 770-205-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14257
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: