Provider Demographics
NPI:1871025841
Name:HUSSAINI, AFSHA
Entity Type:Individual
Prefix:
First Name:AFSHA
Middle Name:
Last Name:HUSSAINI
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 1:2914 CHEROKEE ST NW STE 1A
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6526
Mailing Address - Country:US
Mailing Address - Phone:404-446-6171
Mailing Address - Fax:
Practice Address - Street 1:2914 CHEROKEE ST NW STE 1A
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6526
Practice Address - Country:US
Practice Address - Phone:404-446-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020596363LF0000X
GARN232356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily