Provider Demographics
NPI:1225724271
Name:DIANAT, ASHKAN
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:DIANAT
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 1:5901 GOSHEN SPRINGS RD STE H
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3506
Mailing Address - Country:US
Mailing Address - Phone:770-500-3834
Mailing Address - Fax:833-994-0847
Practice Address - Street 1:5901 GOSHEN SPRINGS RD STE H
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3506
Practice Address - Country:US
Practice Address - Phone:770-500-3834
Practice Address - Fax:833-994-0847
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist