Provider Demographics
NPI:1497102073
Name:ALLIBHOY, ROZINA (NP)
Entity type:Individual
Prefix:MRS
First Name:ROZINA
Middle Name:
Last Name:ALLIBHOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 ROYAL SAINT GEORGES WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4045 FIVE FORKS TRICKUM RD SW STE C13
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7630
Practice Address - Country:US
Practice Address - Phone:470-415-8328
Practice Address - Fax:770-264-4755
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172068207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02151981OtherDATE OF BIRTH