Provider Demographics
NPI:1134303993
Name:MOUSSELLI, NAZIR A (DC)
Entity type:Individual
Prefix:DR
First Name:NAZIR
Middle Name:A
Last Name:MOUSSELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NAZIR
Other - Middle Name:A
Other - Last Name:MOUSSELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:887 N INDIAN CREEK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2242
Mailing Address - Country:US
Mailing Address - Phone:770-449-2700
Mailing Address - Fax:
Practice Address - Street 1:887 N INDIAN CREEK DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2242
Practice Address - Country:US
Practice Address - Phone:770-449-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor