Provider Demographics
NPI:1184351447
Name:HOSSEINI, MARAL
Entity type:Individual
Prefix:
First Name:MARAL
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARAL
Other - Middle Name:
Other - Last Name:HOSSEINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:149 STARGAZE RDG
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5149
Mailing Address - Country:US
Mailing Address - Phone:404-952-3138
Mailing Address - Fax:
Practice Address - Street 1:149 STARGAZE RDG
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5149
Practice Address - Country:US
Practice Address - Phone:404-952-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty