Provider Demographics
NPI:1972187706
Name:NEZAFAT, KIMIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMIA
Middle Name:
Last Name:NEZAFAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 FRANKLIN LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3711
Mailing Address - Country:US
Mailing Address - Phone:678-699-0539
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 825
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1771
Practice Address - Country:US
Practice Address - Phone:404-255-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant