Provider Demographics
NPI:1609650639
Name:DOUGSIYEH, AYAN MUKTAR
Entity Type:Individual
Prefix:
First Name:AYAN
Middle Name:MUKTAR
Last Name:DOUGSIYEH
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 1:775 STILLROCK DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9502
Mailing Address - Country:US
Mailing Address - Phone:404-502-1174
Mailing Address - Fax:
Practice Address - Street 1:775 STILLROCK DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9502
Practice Address - Country:US
Practice Address - Phone:404-502-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician