Provider Demographics
NPI:1497170492
Name:AGOLLI, GEZ (ND, PHD)
Entity Type:Individual
Prefix:
First Name:GEZ
Middle Name:
Last Name:AGOLLI
Suffix:
Gender:M
Credentials:ND, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 N SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6308
Mailing Address - Country:US
Mailing Address - Phone:770-676-6000
Mailing Address - Fax:770-392-9805
Practice Address - Street 1:4646 N SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6308
Practice Address - Country:US
Practice Address - Phone:770-676-6000
Practice Address - Fax:770-392-9805
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath