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General NPI Number Information
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NPI Number | 1215936208
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Entity Type | Individual
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Provider Name | ZAZA GODZIASHVILI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2010 15TH STREET
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City | BAY CITY
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State | MI
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Zip | 48708
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Country | US
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Telephone | 989-894-5621
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Fax | 989-893-3528
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Provider Business Mailing Address
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Address Line | 2010 15TH STREET
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City | BAY CITY
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State | MI
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Zip | 48708
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Country | US
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Telephone | 989-894-5621
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Fax | 989-893-3528
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 220270
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 73175
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301075665
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License Number State | MI
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