# MOFAZZAL SURAIYA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447558010
- **Authorized official:** JAMIL IMRAN M.D. (OWNER)
- **Authorized official phone:** (404) 587-8500

## Contact information

- **Practice address:** 1015 OMAHA DR, NORCROSS, GA 30093-4967
- **Practice address phone:** (404) 587-8500
- **Practice address fax:** (770) 939-5682
- **Mailing address:** 2775 CRUSE RD, SUITE 101, LAWRENCEVILLE, GA 30044-7140
- **Mailing address phone:** (404) 587-8500
- **Mailing address fax:** (770) 939-5682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/07/2011
- **Last updated:** 03/07/2011