Provider Demographics
NPI:1437174174
Name:DZAGNIDZE, IANA G (MD)
Entity Type:Individual
Prefix:DR
First Name:IANA
Middle Name:G
Last Name:DZAGNIDZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:493 CHATEAU DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1924
Mailing Address - Country:US
Mailing Address - Phone:404-869-0203
Mailing Address - Fax:
Practice Address - Street 1:340 BOULEVARD NE
Practice Address - Street 2:SUITE 324
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1273
Practice Address - Country:US
Practice Address - Phone:404-849-9542
Practice Address - Fax:404-521-9261
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0568212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry