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General NPI Number Information
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NPI Number | 1134853427
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Entity Type | Individual
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Provider Name | KOVITA SANJAY BHASIN MS, APC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 1355 TERRELL MILL RD SE
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City | MARIETTA
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State | GA
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Zip | 30067-5496
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Country | US
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Telephone | 470-893-1052
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Fax |
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Provider Business Mailing Address
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Address Line | 1677 MARAKANDA TRL
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City | SUGAR HILL
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State | GA
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Zip | 30518-2956
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Country | US
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Telephone | 612-666-5453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC008567
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License Number State | GA
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