Healthcare Provider Details

I. General information

NPI: 1710810627
Provider Name (Legal Business Name): ENDOSCOPY LASER INSTITUTE OF ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD STE 276
SANDY SPRINGS GA
30342-1710
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD STE 276
SANDY SPRINGS GA
30342-1710
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-8778
  • Fax: 404-255-5627
Mailing address:
  • Phone: 404-255-8778
  • Fax: 404-255-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CEANA NEZHAT
Title or Position: MD
Credential: MD
Phone: 404-255-8778