Organization
MOFAZZAL SURAIYA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIL IMRAN M.D. (OWNER)
(404) 587-8500
Entity
Organization
Contact information
Practice address
1015 OMAHA DR, NORCROSS, GA 30093-4967
(404) 587-8500
(770) 939-5682
Mailing address
2775 CRUSE RD, SUITE 101, LAWRENCEVILLE, GA 30044-7140
(404) 587-8500
(770) 939-5682
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/07/2011
Last updated
03/07/2011
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