Healthcare Provider Details

I. General information

NPI: 1154526457
Provider Name (Legal Business Name): ALAN GEORGE CZARKOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 EXECUTIVE PARK SOUTH NE BLDG 57, SUITE 2301
ATLANTA GA
30329-2288
US

IV. Provider business mailing address

PO BOX 1397
DECATUR GA
30031-1397
US

V. Phone/Fax

Practice location:
  • Phone: 404-498-4775
  • Fax:
Mailing address:
  • Phone: 404-498-4775
  • Fax: 404-498-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number029317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: