Healthcare Provider Details

I. General information

NPI: 1558657080
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER KRAFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE F210
ATLANTA GA
30342-1688
US

IV. Provider business mailing address

993 JOHNSON FERRY RD STE F210
ATLANTA GA
30342-1688
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1727
  • Fax: 404-242-3591
Mailing address:
  • Phone: 404-256-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD452208
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT198929
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number72374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: