Provider Demographics
NPI:1023233251
Name:MAHALLATI, NAVID SHARIF (DC)
Entity type:Individual
Prefix:DR
First Name:NAVID
Middle Name:SHARIF
Last Name:MAHALLATI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 ALPHARETTA HWY STE D4
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5645
Mailing Address - Country:US
Mailing Address - Phone:770-401-4306
Mailing Address - Fax:404-662-2192
Practice Address - Street 1:11205 ALPHARETTA HWY
Practice Address - Street 2:SUITE D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5610
Practice Address - Country:US
Practice Address - Phone:770-401-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor