Organization
MOFAZZAL SURAIYA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALIJA RIVANOVIC (OWNER)
(678) 751-1776
Entity
Organization
Contact information
Practice address
3675 CRESTWOOD PKWY NW STE 405, DULUTH, GA 30096-5129
(678) 751-1776
Mailing address
2032 WILDCAT FALLS LN, LAWRENCEVILLE, GA 30043-2985
(678) 751-1776
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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