Provider Demographics
NPI:1215416664
Name:WAZIRI, FATOUMATA
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:
Last Name:WAZIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 PADEN MILL TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6367
Mailing Address - Country:US
Mailing Address - Phone:240-501-9474
Mailing Address - Fax:
Practice Address - Street 1:591 PADEN MILL TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6367
Practice Address - Country:US
Practice Address - Phone:240-501-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty