Provider Demographics
NPI:1568713725
Name:MODARESI, TANNAZ (DC)
Entity Type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:MODARESI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HOLCOMB BRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2230
Mailing Address - Country:US
Mailing Address - Phone:770-800-1000
Mailing Address - Fax:770-800-1000
Practice Address - Street 1:3800 HOLCOMB BRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2230
Practice Address - Country:US
Practice Address - Phone:770-800-1000
Practice Address - Fax:770-800-1000
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor