Healthcare Provider Details

I. General information

NPI: 1275713554
Provider Name (Legal Business Name): HAFIZA AZIZ UKANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 MOSSY BRANCH DR
SNELLVILLE GA
30078-7777
US

IV. Provider business mailing address

2445 MOSSY BRANCH DR
SNELLVILLE GA
30078-7777
US

V. Phone/Fax

Practice location:
  • Phone: 678-777-7859
  • Fax:
Mailing address:
  • Phone: 678-777-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN137261
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: