Provider Demographics
NPI:1801429576
Name:KHOROZIAN, JACQUES (PHD NBCC, CADC, SA)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:KHOROZIAN
Suffix:
Gender:M
Credentials:PHD NBCC, CADC, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 375
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7405
Mailing Address - Country:US
Mailing Address - Phone:404-594-1770
Mailing Address - Fax:770-648-5797
Practice Address - Street 1:1755 THE EXCHANGE SE STE 375
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7405
Practice Address - Country:US
Practice Address - Phone:404-594-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1770947871OtherPRACTICE ORGANIZATION'S NPI