Provider Demographics
NPI:1841815925
Name:MOTAKEF, GHAZAL
Entity type:Individual
Prefix:
First Name:GHAZAL
Middle Name:
Last Name:MOTAKEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 VICTORIAN LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5769
Mailing Address - Country:US
Mailing Address - Phone:678-551-0442
Mailing Address - Fax:
Practice Address - Street 1:365 VICTORIAN LN
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5769
Practice Address - Country:US
Practice Address - Phone:678-551-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-14
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367H00000X
GA10053367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant