Provider Demographics
NPI:1063660793
Name:ZANOV, MARAT V
Entity Type:Individual
Prefix:DR
First Name:MARAT
Middle Name:V
Last Name:ZANOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 LAWRENCEVILLE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3267
Mailing Address - Country:US
Mailing Address - Phone:404-634-3400
Mailing Address - Fax:
Practice Address - Street 1:KENNER ARMY HEALTH CLINIC
Practice Address - Street 2:700 24TH STREET
Practice Address - City:FORT GREGG-ADAMS
Practice Address - State:VA
Practice Address - Zip Code:23801
Practice Address - Country:US
Practice Address - Phone:804-734-9143
Practice Address - Fax:804-734-9188
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26283103TC0700X, 103TC0700X
KS1968103TC0700X
GAPSY003872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty