Provider Demographics
NPI:1194742965
Name:ALAZRAKI, NAOMI (MD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:ALAZRAKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAOMI
Other - Middle Name:ALAZRAKI
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1220 TYNECASTLE WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3516
Mailing Address - Country:US
Mailing Address - Phone:404-728-7629
Mailing Address - Fax:404-327-4980
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-728-7629
Practice Address - Fax:404-327-4980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029131207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD28773Medicare UPIN