Healthcare Provider Details

I. General information

NPI: 1366228900
Provider Name (Legal Business Name): YURIY KOLIVOSHKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY
ALPHARETTA GA
30005-4248
US

IV. Provider business mailing address

3180 N POINT PKWY
ALPHARETTA GA
30005-4248
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: