Individual
DR. ALI MORTAZAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2041 MESA VALLEY WAY, SUITE 100, AUSTELL, GA 30106-8157
(770) 944-1100
(770) 944-6469
Mailing address
2041 MESA VALLEY WAY, SUITE 100, AUSTELL, GA 30106-8157
(770) 944-1100
(770) 944-6469
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
054865
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234083867A
—
GA
05
—
234083867B
—
GA
05
—
234083867C
—
GA
05
—
234083867E
—
GA
Enumeration date
10/03/2005
Last updated
10/24/2016
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