Provider Demographics
NPI:1619456837
Name:AMOUZEGAR ASLI, SANAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:AMOUZEGAR ASLI
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 1:857 COLLIER RD NW STE 6
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2544
Mailing Address - Country:US
Mailing Address - Phone:404-351-5933
Mailing Address - Fax:
Practice Address - Street 1:857 COLLIER RD NW STE 6
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2544
Practice Address - Country:US
Practice Address - Phone:404-351-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR009745OtherCHIROPRACTIC LICENSE