Healthcare Provider Details

I. General information

NPI: 1821034471
Provider Name (Legal Business Name): AGNES E KOVACS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3867 ROSWELL RD
ATLANTA GA
30342-4451
US

IV. Provider business mailing address

3151 LE CONTE AVE NE
ATLANTA GA
30319-2435
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-5611
  • Fax:
Mailing address:
  • Phone: 404-869-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number056122
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: