Provider Demographics
NPI:1770677924
Name:TOZZI, ANOUSITH SRIRATANAKOUL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANOUSITH
Middle Name:SRIRATANAKOUL
Last Name:TOZZI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PARK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4481
Mailing Address - Country:US
Mailing Address - Phone:404-964-4093
Mailing Address - Fax:404-378-5237
Practice Address - Street 1:6035 PEACHTREE RD
Practice Address - Street 2:C-120
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-3230
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:678-279-7370
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA658938736AMedicaid