Provider Demographics
NPI:1154791820
Name:KAZZ CARE LLC
Entity type:Organization
Organization Name:KAZZ CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-944-6548
Mailing Address - Street 1:771 REEVES LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5239
Mailing Address - Country:US
Mailing Address - Phone:404-944-6548
Mailing Address - Fax:
Practice Address - Street 1:771 REEVES LAKE DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5239
Practice Address - Country:US
Practice Address - Phone:404-944-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009027261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service