Provider Demographics
NPI:1679142244
Name:NOROUZI, NEDA (DO)
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:NOROUZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 GILHAMS RD NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5743
Mailing Address - Country:US
Mailing Address - Phone:404-307-6584
Mailing Address - Fax:
Practice Address - Street 1:400 ERNEST W BARRETT PKWY NW STE 617
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4997
Practice Address - Country:US
Practice Address - Phone:770-727-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty