Provider Demographics
NPI:1366832388
Name:HAJI, ANISHA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANISHA
Middle Name:
Last Name:HAJI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ASHFORD CTR N STE 305
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2682
Mailing Address - Country:US
Mailing Address - Phone:770-727-0772
Mailing Address - Fax:770-766-1117
Practice Address - Street 1:3393 PEACHTREE RD NE STE B128
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1197
Practice Address - Country:US
Practice Address - Phone:770-727-0772
Practice Address - Fax:770-766-1117
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 002857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT002857OtherOD LICENSE NUMBER