Provider Demographics
NPI:1043731888
Name:KAZEROONIAN, ROGHIEH BEIGOM (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROGHIEH
Middle Name:BEIGOM
Last Name:KAZEROONIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3507
Mailing Address - Country:US
Mailing Address - Phone:770-945-4800
Mailing Address - Fax:
Practice Address - Street 1:2721 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3507
Practice Address - Country:US
Practice Address - Phone:770-945-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily