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General NPI Number Information
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NPI Number | 1912377433
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Entity Type | Organization
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Legal Business Name | CASSANDRA WANZO MD PC
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Dates
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Enumeration Date | 09/26/2015
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Last Update Date | 09/26/2015
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Provider Practice Location Address
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Address Line | 602 BOMBAY LN
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City | ROSWELL
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State | GA
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Zip | 30076-5828
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Country | US
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Telephone | 678-566-1440
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Fax | 678-566-1442
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Provider Business Mailing Address
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Address Line | 602 BOMBAY LN
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City | ROSWELL
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State | GA
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Zip | 30076-5828
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Country | US
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Telephone | 678-566-1440
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Fax | 678-566-1442
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASSANDRA L WANZO
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Credential | M.D.
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Telephone | 678-566-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35165
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License Number State | GA
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