Provider Demographics
NPI:1215936208
Name:GODZIASHVILI, ZAZA (MD)
Entity type:Individual
Prefix:DR
First Name:ZAZA
Middle Name:
Last Name:GODZIASHVILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-894-5621
Mailing Address - Fax:989-893-3528
Practice Address - Street 1:2010 15TH STREET
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-894-5621
Practice Address - Fax:989-893-3528
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220270207L00000X
CT73175207L00000X
MI4301075665207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2102625Medicaid
MI1215936208OtherNPI