Individual
DR. FAZEELA GHANNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2000 RIVERSIDE PARKWAY, SUITE 200, LAWRENCEVILLE, GA 30044
(678) 836-2109
(770) 441-0299
Mailing address
3194 CLUBSIDE VIEW CT, SNELLVILLE, GA 30039-4722
(615) 327-9195
(770) 441-0299
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
013167
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013167
DENTIST
GA
Enumeration date
10/04/2006
Last updated
01/04/2016
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