Healthcare Provider Details

I. General information

NPI: 1568087708
Provider Name (Legal Business Name): NZOTA PELAGIE NSONA KOYAGIALO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 MACK DOBBS RD NW
KENNESAW GA
30152-2641
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4314
  • Fax: 470-251-6052
Mailing address:
  • Phone: 770-914-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: