Provider Demographics
NPI:1558940817
Name:ZEZETKO, ALISA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:ZEZETKO
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLONIAL CENTER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4892
Mailing Address - Country:US
Mailing Address - Phone:332-222-3138
Mailing Address - Fax:
Practice Address - Street 1:300 COLONIAL CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4892
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:888-815-3583
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME78062084P0800X
NY3365002084P0800X
CODR.00749992084P0800X
GA1039602084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry