Individual
DAWN MAZIE ITZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
771 OLD NORCROSS RD, SUITE 255, LAWRENCEVILLE, GA 30046-4386
(770) 963-2967
(770) 339-4585
Mailing address
771 OLD NORCROSS RD, SUITE 255, LAWRENCEVILLE, GA 30046-4386
(770) 963-2967
(770) 339-4585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003340
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003340
STATE LICENSE
GA
Enumeration date
01/25/2008
Last updated
02/03/2015
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