Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 028011 | GA |
NPI | 1043211949 |
---|---|
Provider Name | Dr. Yazan Houssami |
First Address | Lawrenceville, GA 30046-7651 |
Second Address | Lawrenceville, GA 30046-7651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000311011A | (05) | GA |
D29801 | (02) | GA |