Provider Demographics
NPI:1497102073
Name:ALLIBHOY, ROZINA
Entity Type:Individual
Prefix:MRS
First Name:ROZINA
Middle Name:
Last Name:ALLIBHOY
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 1:1707 MANOR BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3060
Mailing Address - Country:US
Mailing Address - Phone:678-793-4820
Mailing Address - Fax:
Practice Address - Street 1:1707 MANOR BROOK WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3060
Practice Address - Country:US
Practice Address - Phone:678-793-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02151981OtherDATE OF BIRTH