Provider Demographics
NPI:1225376445
Name:HAZEN, DEBORAH MORRIS
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MORRIS
Last Name:HAZEN
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 1:1105 WOODRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8921
Mailing Address - Country:US
Mailing Address - Phone:770-356-7450
Mailing Address - Fax:
Practice Address - Street 1:1451 RIVERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5624
Practice Address - Country:US
Practice Address - Phone:770-720-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist