Healthcare Provider Details

I. General information

NPI: 1275456824
Provider Name (Legal Business Name): ZAINAB ANSAR RAJA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 CANDLER RD STE 101
DECATUR GA
30034-1421
US

IV. Provider business mailing address

753 ROCK LN
MCDONOUGH GA
30253-4314
US

V. Phone/Fax

Practice location:
  • Phone: 404-244-1166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH046143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: