Basic Information
| Provider Information | |||||||||
| NPI: | 1750712386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOZO PSYCHIATRIC PROFESSIONAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 967 | ||||||||
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| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300960018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708818495 | ||||||||
| FaxNumber: | 7702378200 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TECHNOLOGY PKWY S | ||||||||
| Address2: | |||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300922928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787132600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2013 | ||||||||
| LastUpdateDate: | 12/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | IMAM | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | AMJAD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7708818495 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 68148 | GA | Y | Hospitals | Psychiatric Hospital |
No ID Information.