Healthcare Provider Details

I. General information

NPI: 1861625477
Provider Name (Legal Business Name): CAROLINE OCZACHOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 DUNWOODY PARK SUITE 150
ATLANTA GA
30338-7408
US

IV. Provider business mailing address

11 DUNWOODY PARK SUITE 150
ATLANTA GA
30338-7408
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6920
  • Fax:
Mailing address:
  • Phone: 404-778-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number003986
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: