Provider Demographics
NPI:1548889405
Name:PERVIZ, AMIRA (DO)
Entity type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:
Last Name:PERVIZ
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 JONES BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-0001
Mailing Address - Country:US
Mailing Address - Phone:678-383-0008
Mailing Address - Fax:
Practice Address - Street 1:11125 JONES BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-0001
Practice Address - Country:US
Practice Address - Phone:678-383-0008
Practice Address - Fax:470-735-6656
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0097832084P0800X
390200000X
GA1023742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program