Provider Demographics
NPI:1750712386
Name:SOZO PSYCHIATRIC PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:SOZO PSYCHIATRIC PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:AMJAD
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-881-8495
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0018
Mailing Address - Country:US
Mailing Address - Phone:770-881-8495
Mailing Address - Fax:770-237-8200
Practice Address - Street 1:1 TECHNOLOGY PKWY S
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2928
Practice Address - Country:US
Practice Address - Phone:678-713-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68148283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital