Provider Demographics
NPI:1700335627
Name:GASSIM, JUMA
Entity Type:Individual
Prefix:
First Name:JUMA
Middle Name:
Last Name:GASSIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 ROSWELL RD
Mailing Address - Street 2:APT. F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-7045
Mailing Address - Country:US
Mailing Address - Phone:404-483-2021
Mailing Address - Fax:
Practice Address - Street 1:7949 ROSWELL RD.
Practice Address - Street 2:APT. F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:404-483-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11-220246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant