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Organization
MOFAZZAL SURAIYA LLC
Active
Organization
MOFAZZAL SURAIYA LLC
Active
Other names
m and s homecare services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMIL IMRAN (PRESIDENT)
(404) 587-8500
Entity
Organization
Contact information
Practice address
2775 CRUSE RD STE 101, LAWRENCEVILLE, GA 30044-7141
(404) 587-8500
(770) 939-5682
Mailing address
1015 OMAHA DR, NORCROSS, GA 30093-4967
(404) 587-8500
(770) 939-5682
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
067-R-0459
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221998235A
—
GA
Enumeration date
11/05/2010
Last updated
11/05/2010
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