Healthcare Provider Details

I. General information

NPI: 1700840147
Provider Name (Legal Business Name): ALAN M KOZARSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 115
ATLANTA GA
30327-2100
US

IV. Provider business mailing address

3225 CUMBERLAND BLVD SE SUITE 900
ATLANTA GA
30339-6407
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1425
  • Fax: 404-350-1429
Mailing address:
  • Phone: 404-351-2220
  • Fax: 404-355-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number023619
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number023619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: