# MOFAZZAL SURAIYA LLC

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

## Provider details

- **NPI number:** 1497624134
- **Authorized official:** ALIJA RIVANOVIC (OWNER)
- **Authorized official phone:** (678) 751-1776

## Contact information

- **Practice address:** 3675 CRESTWOOD PKWY NW STE 405, DULUTH, GA 30096-5129
- **Practice address phone:** (678) 751-1776
- **Mailing address:** 2032 WILDCAT FALLS LN, LAWRENCEVILLE, GA 30043-2985
- **Mailing address phone:** (678) 751-1776

## Taxonomy

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

## Other

- **Enumeration date:** 10/31/2025
- **Last updated:** 10/31/2025