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Individual

ANISA T DAFTARI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
5673 PEACHTREE DUNWOODY RD NE, STE150, ATLANTA, GA 30342-1731
(404) 297-1780
(770) 234-9979
Mailing address
4380 GEORGETOWN SQ, STE 1002, ATLANTA, GA 30338-6254
(770) 220-8400
(770) 234-9979

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3298
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003298
PHYSICIAN ASSISTANT LICENSE
GA
Enumeration date
07/24/2009
Last updated
08/28/2020
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