Provider Demographics
NPI:1932758497
Name:AZIZ, LATEEFAH
Entity type:Individual
Prefix:MS
First Name:LATEEFAH
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 1/2 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1800
Mailing Address - Country:US
Mailing Address - Phone:404-883-3302
Mailing Address - Fax:678-515-0876
Practice Address - Street 1:889 1/2 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1800
Practice Address - Country:US
Practice Address - Phone:404-883-3302
Practice Address - Fax:678-515-0876
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010489251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care